Asfixia Neonatal
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Transcript of Asfixia Neonatal
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Profesor Titular de Neonatología , Universidad FUCS, Hospital de San José
Profesor Asistente de Pediatría Universidad Militar C., HUCSR
Coordinador URN , Clínica Federman
Esp. Epidemiologia U. Bosque y FUAA
Esp. Docencia universitaria U. FUCS
Investigador grupo Perinatología Hospital de San José Miembro Colciencias
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La asfixia perinatal se puede definir como la
agresión producida al feto o al recién nacido
alrededor del momento del nacimiento por la
falta de oxígeno y/o de una perfusión tisular
adecuada
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Secuelas
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CONCLUSION
El resultado de esta gran cohorte prospectiva
muestra que el lactato es una medida mas
discriminativa de morbilidad en RNAT
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COLOMBIA
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21 veces
11 veces
18 veces
10 veces
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Actualities on molecular pathogenesis and repairing processes of cerebral damage in perinatal hypoxic-ischemic encephalopathy - Italian Journal of Pediatrics 2010, 36:63
apoptosis
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CLINICA
Compromiso
multi-
orgánico
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Sensibilidad 91% - Especificidad 81%
Descartar hemorragias
Advanced neuroimaging techniques for the term newborn with encephalopathy. Pediatr Neurol 2009;40:181-188.
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Ninguno de los cambios
ecográficos fueron predictores
de secuelas durante el primer
año
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CONCLUSION
El patrón del EEG ampliado no adiciona
valor predictivo de muerte o discapacidad
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Estudio mas sensible de lesiones sustancia blanca
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Mide Estado metabólico de una región cerebral
Mediante componentes bioquímicos
N-acetil-aspartato / lactato
Alto en neuronas y aumenta durante maduración
En lesión niveles descienden por disfunción o muerte
Advanced neuroimaging techniques for the term newborn with encephalopathy. Pediatr Neurol 2009;40:181-188.
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CONCLUSION
La troponina I se relaciona significativamente
con el grado de HIE y la duración del soporte
inotrópico
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CONCLUSION
El SFA, LDH, trombocitopenia, neuroimagenes alteradas
son factores asociados significantemente con daño hepático
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Después de la «época de entrenamiento» de los obstetras
se redujo la Encefalopatía Hipoxico Isquémica no severas
86.6/10000 44.4 / 10000
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laboratorios
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Sulfato de magnesio postnatal (250mg/k/dosis x 3 c/24 h
NNT 18
CONCLUSION
La importante mejoría en los resultados a corto plazo** sin incremento de los efectos secundarios
indican la necesidad de futuros estudios…..
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Dosis: 40mg/kg
CONCLUSION
Los datos no son suficientes para determinar el beneficio
de alopurinol… se necesitan mas estudios.. Y como terapia
coadyuvante
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Fenobarbital 20 o 40mg/kg UNA DOSIS disminuye en 27% en la incidencia de convulsiones y mejoría en estado neurológico a los 3 años de vida
Fenobarbital profiláctico puede reducir la frecuencia de convulsiones en infantes asfixiados , sin evidencia que mejore mortalidad o secuelas neurológicas
a largo plazo
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Blanketrol
Tecotherm
AmrrAterm®
Olympic Cool Cap
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3 de lo2 6 items
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Hipotermia no esta asociada con significante reducción en la mortalidad en países con bajo –medios
ingresos…puede ser debido a pobre calidad en los estudios , insuficiente tecnología de los dispositivos
de enfriamiento, falta de optimo cuidado intensivo/sedacion /ventilación, , sobre-uso de oxigeno,
diferencias intrínsecas en la población ( > infección, RCIU, DNT materna)
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La evidencia sobre 11 estudios con 1505 infantes dice que la Hipotermia en beneficiosa en el RNAT y
RNPT tardio… Reduce mortalidad sin incrementar discapacidad… Sin mayores efectos secundarios..
La hipotermia debe ser instituida en estos infantes con encefalopatía moderada a severa…
Se necesitan estudios para determinar la técnica y método apropiados ,duración …
según grado de E.H.I
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la trombocitopenia
por hipotermia no
produce mas
Hemorragias o
sangrado cerebral
2014
trombocitopenia
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CONCLUSION La tasa combinada de muerte o un coeficiente intelectual inferior
a 70 a las 6- 7 años de edad fue menor en los niños sometidos a
hipotermia
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• Anestésico en Europa
• Inhibición de AMPA
• Reduce lib. Neurotrasmisores
• Antagonismo NMDA
• Reducción lesión tisular
• Reducción muerte neuronal
• Costos y estudios
Xenón
topiramato
EPO
Neuroprotective Role of
Erythropoietin in Perinatal Asphyxia
Stem cells
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