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Managing Seizures in Newborns with Hypoxic-Ischemic Encephalopathy: The Role of Telehealth and Remote Neuromonitoring

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Anthony Raphael
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Managing Seizures in Newborns with Hypoxic-Ischemic Encephalopathy: The Role of Telehealth and Remote Neuromonitoring

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Hypoxic-ischemic encephalopathy (HIE) in newborns is a serious neurological syndrome commonly associated with term or late preterm infants. It is linked with mortality and long-term disabilities such as cerebral palsy and other developmental impairments. A study from Brazil has presented a novel approach to manage seizures in newborns with HIE, utilizing a telehealth model and remote neuromonitoring approach with video aEEG/EEG.

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Understanding Hypoxic-Ischemic Encephalopathy

Hypoxia-ischemia is a common cause of neonatal encephalopathy. This condition occurs when there is a lack of oxygen or blood flow to the baby's brain before, during, or after birth. The incidence of neonatal encephalopathy ranges from 2.0 to 6.0 per 1000 live births, with a higher incidence in poorer countries.

One of the standard treatments for HIE is therapeutic hypothermia. However, this treatment has limitations, and researchers are investigating other treatments such as erythropoietin, darbepoetin, melatonin, and magnesium sulfate as stand-alone or adjuvant treatments.

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The Role of Therapeutic Hypothermia in Managing HIE

Therapeutic hypothermia has emerged as an effective treatment for neonatal encephalopathy which can result in serious health consequences including death, cerebral palsy, developmental delay, and seizure disorder. Nurses play a large role in identifying and caring for infants receiving therapeutic hypothermia and their families.

The Promise of Remote Seizure Monitoring

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A recent study on the management of seizures in newborns with HIE during therapeutic hypothermia through remote monitoring and a telehealth-based model has shown promising results. The study involved 872 cooled newborns and found that 33.9% of the infants experienced electrographic seizures. There were significant correlations between seizures and certain neurological indicators. The results support the potential of remote neurocritical care.

Exploring Alternative Treatments: The Case of Sildenafil

Administering sildenafil in critically-ill neonates with neonatal encephalopathy in an attempt to repair their brain has been found to be feasible and safe. Several preclinical studies have demonstrated the potential neuroprotective and/or neurorestorative properties of sildenafil in the neonatal brain. Further trials are needed to determine if sildenafil may shift the treatment paradigm of neonatal encephalopathy from solely focusing on supportive care and prevention to an approach stimulating repair of neonatal brain injuries.

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The Importance of Clinical Trials in HIE Research

Clinical trials and research studies play a crucial role in advancing our understanding and management of HIE in newborns. Participation in these trials can help drive the discovery of additional therapeutics and changes in clinical care to decrease the incidence and impact of HIE. The process involves preclinical testing and several phases of clinical trials.

In conclusion, the management of seizures in newborns with HIE is a complex process that continues to evolve. The use of telehealth and remote neuromonitoring approaches, as well as the exploration of alternative treatments such as sildenafil, hold promise for improving outcomes in newborns affected by this condition.

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