Understanding Prognosis In Neonates With Hypoxic-Ischemic Encephalopathy

HIE prognosis: can we predict using early neurological examination and blood-based biomarkers?
Diedre Murray

Predicting prognosis remains challenging, especially in mild and moderate HIE. This talk will cover current knowledge regarding the utility of early neurological examination and blood-based biomarkers for the prediction of motor and cognitive outcome following HIE. There will be a particular focus on predictors which are suitable for use in a low resource setting.

Learning objectives:

• To summarize current evidence on which clinical factors are useful for the prediction of outcome in neonatal HIE
• To summarize current knowledge on the ability of early neurological examination to predict long term outcome in HIE
• To summarize current evidence on the ability of blood-based biomarkers to predict outcome in HIE

Professor Diedre Murray is a Consultant Paediatrician and Chair of the Department of Paediatrics and Child Health, University College Cork. Prof Murray is the Principal Investigator of the Cork BASELINE birth cohort, one of the largest and most detailed mother-child cohorts in Europe. Prof Murray’s research has focused on early brain injury, and the development of new ways to predict and assess neurocognitive outcome in children, particularly after neonatal hypoxic ischaemic encephalopathy.

How advanced technologies can inform HIE prognosis: EEG, MRI, and advanced prediction modeling.
Hannah Glass

Electroencephalogram (EEG) and magnetic resonance imaging (MRI) are standard clinical tools in high resource settings that can provide rich information about presence and degree of brain injury. But do they perform better than clinical features alone? This talk will explore results from large, multicenter studies to demonstrate how clinical, EEG, and MRI factors can be used alone and in combination to predict prognosis.

Learning objectives:
• Know the evidence for continuous video EEG and/or amplitude integrated EEG (aEEG) for predicting prognosis after HIE
• Know the evidence for conventional MRI and MR spectroscopy (MRS) for predicting prognosis after HIE
• Learn to use prediction models that incorporate clinical, EEG, and MRI factors to predict prognosis.

Dr. Glass is a Professor of Neurology and Pediatrics at University of California, San Francisco. She directs the UCSF Neonatal Neurocritical Care Program and conducts research to improve the lives of newborns with brain injury, including as Principal Investigator of the Neonatal Seizure Registry.

HIE as a Cause of Cerebral Palsy in Low and High Resource Settings
Thembi Katangwe

Cerebral palsy (CP) remains the most important cause of motor disability in children globally. Significant differences exist in the CP birth prevalence in Low- and Medium-Income Countries LMICs and High-Income Countries HICs. The low CP prevalence and decline in CP severity in High Income Countries has been attributed to improvement in perinatal health care quality and early CP diagnosis and initiation of therapy. According to World Health Organization (WHO) data estimates, 80% of the world’s disabled population (adults and children) live in LMICs, many in Africa. However, data paucity remains a huge challenge in many of these settings to confirm these estimations. It is also postulated that hypoxic ischemic encephalopathy (HIE) is one of the main drivers of CP in these regions. Therefore, for LMICs to lower CP prevalence, up to date data on CP risk factors is needed so targeted CP preventative strategies may be implemented.

Learning objectives
• CP prevalence in LMICs still is higher than in HICs
• HIE is one of the main drivers of CP in LMICs
• Data paucity on CP risk factors in many of the LMICs hinders the implementation of policy driven CP preventative strategies

Dr Thembi Katangwe, is a Paediatric Neurologist and PhD Candidate at Stellenbosch University’s Department of Paediatrics and Child Health.

Headlines, Hopes, and Hardships: Building Prognostic Awareness in Families Affected by HIE
Lauren Treat

Communicating medical information and expert opinion in a culturally-sensitive manner is a core task of high-quality health care. This information exchange is particularly important after a child has sustained hypoxic ischemic brain injury, as family members are often faced with decision making tasks and look to their medical team for balanced information about possible outcomes. In this talk, a child neurologist who is dual-trained in pediatric palliative medicine will highlight the uniqueness of parental decision making as well as severe acute brain injury as compared to other types of serious illness in order to frame effective communication strategies. The concept of prognostic awareness with be explored alongside tools to help clinicians communicate their own assessments and build prognostic awareness in families over time.
Learning objectives:
• Acknowledge unique factors that require tailored communication strategies for discussing prognosis in children with HIE
• Assess prognostic awareness in families of children with HIE and recognize opportunities to affect the way families build prognostic awareness over time
• Identify concrete communication strategies for incorporation into clinical practice

Dr. Lauren Treat is a child neurologist who has special training in caring for individuals with life-limiting and life-altering diseases. Her focus is on helping individuals with serious illness live as well as possible for as long as possible.