Critères de traitement :
Critère A : Nouveau-nés âgés de plus de 34 semaines ayant terminé leur AG avec au moins 1 des paramètres d'acidose sévère :
- Apgar moins de 5 à 5 minutes.
- Réanimation en salle d'accouchement pendant plus de 10 minutes, par ventilation à pression positive (masque ou sonde endotrachéale).
- pH inférieur à 7 dans la pire gazométrie de la première heure de vie (sang de cordon, artériel, veineux ou capillaire).
- Déficit de base supérieur à 16 mmol/L lors de la pire analyse des gaz du sang de la première heure de vie (sang de cordon, artériel, veineux ou capillaire).
Critère B. Tous les nouveau-nés qui répondent au critère A seront évalués neurologiquement selon le critère B.
- Saisies.
- Symptômes d'HIE modérés ou sévères : Les 3 critères suivants doivent être remplis :
- État de conscience altéré (diminution ou absence de réponse à la stimulation).
- Tonus anormal (hypotonie focale ou généralisée).
- Réflexes primitifs anormaux (succion faible/absente, Moro anormal, etc.).
Critère C : Traçage électroencéphalographique. Dès que possible et pendant au moins 30 minutes, l'activité sera surveillée avec aEEG.
Deux situations peuvent se produire :
- aEEG normal (CNV) : dans les 6 premières heures de vie, il indique une forte probabilité d'un pronostic neurologique normal et, si l'examen neurologique est cohérent (HIE léger), l'arrêt de l'hypothermie sera envisagé. Dans la mesure du possible, il doit être comparé à un EEG conventionnel.
- AEEG altéré : corrobore le diagnostic d’EHI modéré à sévère et le traitement doit être poursuivi pendant 72 heures :
- Traçage de la ligne de base normale (CNV) avec convulsions.
- Statut d'épilepsie.
- Traçage de base modifié : DNV, suppression d'épidémie.
- Trace de base supprimée : basse tension, isoélectrique.
19955111
{19955111:QL4US6UJ}
1
Vancouver
50
défaut
4180
https://neuropediatoolkit.org/wp-content/plugins/zotpress/
%7B%22status%22%3A%22success%22%2C%22updateneeded%22%3Afalse%2C%22instance%22%3Afalse%2C%22meta%22%3A%7B%22request_last%22%3A0%2C%22request_next%22%3A0%2C%22used_cache%22%3Atrue%7D%2C%22data%22%3A%5B%7B%22key%22%3A%22QL4US6UJ%22%2C%22library%22%3A%7B%22id%22%3A19955111%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Arnaez%20et%20al.%22%2C%22parsedDate%22%3A%222018%22%2C%22numChildren%22%3A1%7D%2C%22bib%22%3A%22%26lt%3Bdiv%20class%3D%26quot%3Bcsl-bib-body%26quot%3B%20style%3D%26quot%3Bline-height%3A%201.35%3B%20%26quot%3B%26gt%3B%5Cn%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-entry%26quot%3B%20style%3D%26quot%3Bclear%3A%20left%3B%20%26quot%3B%26gt%3B%5Cn%20%20%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-left-margin%26quot%3B%20style%3D%26quot%3Bfloat%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%26quot%3B%26gt%3B1.%26lt%3B%5C%2Fdiv%26gt%3B%26lt%3Bdiv%20class%3D%26quot%3Bcsl-right-inline%26quot%3B%20style%3D%26quot%3Bmargin%3A%200%20.4em%200%201.5em%3B%26quot%3B%26gt%3BArnaez%20J%2C%20Garcia-Alix%20A%2C%20Calvo%20S%2C%20Lubi%26%23xE1%3Bn-L%26%23xF3%3Bpez%20S.%20Asistencia%20en%20Espa%26%23xF1%3Ba%20del%20reci%26%23xE9%3Bn%20nacido%20con%20asfixia%20perinatal%20candidato%20a%20hipotermia%20terap%26%23xE9%3Butica%20durante%20las%20primeras%20seis%20horas%20de%20vida.%20Anales%20de%20Pediatr%26%23xED%3Ba%20%5BInternet%5D.%202018%20%5Bcited%202022%20Dec%2019%5D%3B89%284%29%3A211%26%23x2013%3B21.%20Available%20from%3A%20%26lt%3Ba%20class%3D%26%23039%3Bzp-ItemURL%26%23039%3B%20href%3D%26%23039%3Bhttps%3A%5C%2F%5C%2Flinkinghub.elsevier.com%5C%2Fretrieve%5C%2Fpii%5C%2FS1695403317304496%26%23039%3B%26gt%3Bhttps%3A%5C%2F%5C%2Flinkinghub.elsevier.com%5C%2Fretrieve%5C%2Fpii%5C%2FS1695403317304496%26lt%3B%5C%2Fa%26gt%3B%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%20%20%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%26lt%3B%5C%2Fdiv%26gt%3B%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22Asistencia%20en%20Espa%5Cu00f1a%20del%20reci%5Cu00e9n%20nacido%20con%20asfixia%20perinatal%20candidato%20a%20hipotermia%20terap%5Cu00e9utica%20durante%20las%20primeras%20seis%20horas%20de%20vida%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Juan%22%2C%22lastName%22%3A%22Arnaez%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Alfredo%22%2C%22lastName%22%3A%22Garcia-Alix%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Sara%22%2C%22lastName%22%3A%22Calvo%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Sim%5Cu00f3n%22%2C%22lastName%22%3A%22Lubi%5Cu00e1n-L%5Cu00f3pez%22%7D%5D%2C%22abstractNote%22%3A%22Introduction%3A%20The%20process%20of%20care%20and%20assistance%20from%20birth%20to%20the%20starting%20of%20therapeutic%20hypothermia%20%28TH%29%20is%20crucial%20in%20order%20to%20improve%20its%20effectiveness%20and%20prevent%20the%20worsening%20of%20hypoxic-ischaemic%20injury.%5CnMethods%3A%20A%20national%20cross-sectional%20study%20carried%20out%20in%202015%20by%20use%20of%20a%20questionnaire%20sent%20to%20all%20level%20iii%20units%20on%20the%20care%20of%20the%20newborn%20%5Cu2265%2035%20weeks%20gestation%20within%20the%20%5Cufb01rst%20hours%20of%20life%20after%20a%20perinatal%20asphyxia%20event.%20According%20to%20clinical%20practice%20guidelines%2C%20the%20quality%20of%20care%20was%20compared%20between%20the%20hospitals%20that%20carried%20out%20or%20did%20not%20carry%20out%20TH%2C%20and%20according%20to%20the%20level%20of%20care.%5CnResults%3A%20A%20total%20of%2089%5C%2F90%20hospitals%20participated%2C%20of%20which%2057%5C%2F90%20performed%20TH.%20They%20all%20used%20resuscitation%20protocols%20and%20turned%20off%20the%20radiant%20warmer%20after%20stabilisation.%20All%20of%20them%20performed%20glucose%20and%20blood%20gas%20analysis%2C%20monitored%20the%20central%20temperature%2C%20put%20the%20newborn%20on%20a%20diet%2C%20and%20performed%20at%20least%20two%20examinations%20for%20the%20diagnosis%20of%20hypoxic-ischaemic%20encephalopathy.%20Greater%20than%20one-third%20%2835%25%29%20of%20hospitals%20did%20not%20have%20amplitude-integrated%20electroencephalogram%2C%20and%206%5C%2F57%20were%20TH-hospitals.%20The%20quality%20of%20care%20among%20hospitals%20with%20and%20without%20TH%20was%20similar%2C%20childbirth%20being%20better%20in%20those%20that%20performed%20TH%2C%20and%20those%20with%20a%20higher%20level%20of%20care.%20Level%20IIIc%20hospitals%20had%20higher%20scores%20than%20the%20others.%20The%20TH-hospitals%20mentioned%20not%20always%20having%20neonatologists%20with%20experience%20in%20neurological%20assessment%20and%20interpretation%20of%20amplitude-integrated%20electroencephalogram%20%2825%25%29%2C%20or%20in%20brain%20ultrasound%20%2862%25%29.%5CnConclusions%3A%20In%20response%20to%20the%20recommendations%20of%20the%20asphyxiated%20newborn%2C%20there%20is%20a%20proper%20national%20health%20care%20standard%20with%20differences%20according%20to%20the%20level%20of%20care%20and%20whether%20TH%20is%20offered.%20More%20amplitude-integrated%20electroencephalogram%20devices%20are%20necessary%2C%20as%20well%20as%20more%20neonatologists%20trained%20in%20the%20evaluations%20that%20will%20be%20require%20by%20the%20newborn%20with%20hypoxic-ischaemic%20encephalopathy.%22%2C%22date%22%3A%2210%5C%2F2018%22%2C%22section%22%3A%22%22%2C%22partNumber%22%3A%22%22%2C%22partTitle%22%3A%22%22%2C%22DOI%22%3A%2210.1016%5C%2Fj.anpedi.2017.11.003%22%2C%22citationKey%22%3A%22%22%2C%22url%22%3A%22https%3A%5C%2F%5C%2Flinkinghub.elsevier.com%5C%2Fretrieve%5C%2Fpii%5C%2FS1695403317304496%22%2C%22PMID%22%3A%22%22%2C%22PMCID%22%3A%22%22%2C%22ISSN%22%3A%2216954033%22%2C%22language%22%3A%22es%22%2C%22collections%22%3A%5B%22F3H4DBMI%22%5D%2C%22dateModified%22%3A%222026-05-05T17%3A03%3A21Z%22%7D%7D%5D%7D
1.
Arnaez J, Garcia-Alix A, Calvo S, Lubián-López S. Soins en Espagne des nouveau-nés souffrant d'asphyxie périnatale candidats à l'hypothermie thérapeutique pendant les six premières heures de vie. Annales de pédiatrie [Internet]. 2018 [cité le 19 décembre 2022];89(4):211-21. Disponible à partir de : https://linkinghub.elsevier.com/retrieve/pii/S1695403317304496