Seminars in pediatric neurology
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Semin Pediatr Neurol · Jun 1999
ReviewNew technologies in pediatric neurology. Near-infrared spectroscopy.
Near-infrared spectroscopy (NIRS) is a relatively new technology that offers the enormous advantage of making measurements in vivo of changes in cerebral hemodynamics and oxygenation. Because NIRS is noninvasive and portable, it can provide real-time measurements of these changes at the bedside. ⋯ This review outlines the basic principles, advantages, and limitations of the current state of NIRS technology. An emphasis is placed on the animal and clinical studies that are relevant to the field of child neurology, with an eye to the future evolution and potential applications of this promising technique.
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Monitoring of central nervous system function in the intensive care unit is becoming more widely accepted as an integral part of critical care. The history of developments in electroencephalogram (EEG) technology is reviewed to better appreciate the rate of technological developments and their application to clinical practice. Basic concepts of digital EEG are reviewed. Principals of intensive care unit monitoring as they apply to clinical neurophysiological techniques are examined to better understand the goals for an "ideal central nervous system monitor." Some current advances and directions for future development in computerized EEG monitoring are discussed.
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Semin Pediatr Neurol · Mar 1999
ReviewDevelopmental progress of children with congenital heart defects requiring open heart surgery.
Recent advances for infants requiring early open heart surgery have resulted in a dramatic decline in mortality and severe morbidity. The developmental progress of these new survivors is currently being defined. Causes contributing to brain injury are multifactorial, and may involve preoperative, intraoperative, and postoperative events. ⋯ Long-term follow-up studies indicate that subtle neurological deficits and global developmental lags are characteristic of this population. Overall, severe neurological sequelae are uncommon; however, mild to moderate developmental disabilities are prevalent. Functional limitations, academic achievements, and health-related quality of life are areas that deserve further attention.
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Neurological injury is a major and often debilitating complication of congenital heart disease and open-heart surgery. Paradoxically, the full impact of this complication has been underscored by the marked decrease in mortality and the rescue of infants with desperate and previously lethal heart conditions. ⋯ Inflammatory cascades have been implicated in the end-organ injury seen after cardiopulmonary bypass and might play a role in neurological dysfunction. These mechanisms are reviewed, with an emphasis on recent developments in our understanding of brain injury in this population.
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Semin Pediatr Neurol · Mar 1999
ReviewThe pursuit of effective neuroprotection during infant cardiac surgery.
Advances in infant cardiac surgery have resulted in a dramatic decline in mortality rates; however, neurological morbidity remains an important concern. The effectiveness of a number of interventional strategies to prevent or minimize brain injury during open heart surgery are currently being investigated. This article provides an overview of two approaches: (1) interventions to enhance intraoperative cerebral oxygenation so as to prevent hypoxic-ischemic insults, and (2) the application of cerebral rescue therapies to attenuate the cascade of brain injury. Infant cardiac surgery provides a controlled environment in which to apply these neuroprotective approaches, so as to optimize the quality of life of these vulnerable children.