Perinatal asphyxia-an overview of the pathophysiology and overview of HIE. Dr Sridhar K

[@SridharKs]

Useful playlists for nicu nurses, trainee pediatricians and neonatal trainees NRP-kzbin.info/aero/PLKe2uxLSi6cErI1Y7ZRbLub-1Qq8AT4Bm Oxygen in Neonatology kzbin.info/aero/PLKe2uxLSi6cEDL9Zfc57-YJjlVkqJXmQp Neonatal ventilation-kzbin.info/aero/PLKe2uxLSi6cEk8ExzMpF-5ePzmkteTNjk Neonatal jaundice-kzbin.info/aero/PLKe2uxLSi6cFT5aOxCrU9ENBRXlkUwWzq Breastfeeding-kzbin.info/aero/PLKe2uxLSi6cFdnNrlnJQ8T5P-qaP8erc5 And many short videos to clarify queries of new parents-could help if you cover postnatal ward kzbin.info/aero/PLKe2uxLSi6cEAuXao6M9lsXUmbyhbpL1t

[@SridharKs]

Dr Tamanna asked in another group a question which I am sharing here to benefit others. Sir which part of the brain mainly affected by Perinatal asphyxia? My response-In terms of perinatal asphyxia, the part of the brain affected depends on the acuteness of the insult and whether there was time for compensation (diving reflex). As in most cases it is not acute total asphyxia, watershed area is affected (diving reflex protection exceeded), and as severity increases, basal ganglia, thalamus injury increases. In acute total, it directly hits the central part as above. Involvement of basal ganglia and thalamus is a reflection of severity and poor prognosis if severe

[@ishfaqpir6064]

Every topic of kalyan sir is helpful

[@SridharKs]

Thank you

[@swaspwas]

what is the rationale for therapeutic hypothermia? isn't brain undergoing through hypoxia induced damage and hyopthermia is only going to make it worse? sorry if this question comes off as too silly but i am thinking in terms of how hypothermia=cold= will make hypoxia worse, no? i looked it up and it says hypothermia helps in modulating inflammatory response, decreases edema, helps in preservation of protein synthesis etc etc- so it will halt the inflammation/any effect of the hypoxia/ischaemia? so we are preventing further damage and it is like buying more time for other therapeutic interventions?

[@SridharKs]

Thank you for asking this important question. Hypothermia can't reverse the initial brain injury. But by slowing down the metabolic processes, it reduces the secondary brain injury during the reperfusion phase, which contributes significantly to the apoptosis and related brain injury. Hope this answers your question-and that is why timing is very important, you need to cool before the reperfusion starts. There is a video in 2 days on this topic, do watch

[@swaspwas]

@@SridharKs thank you for your response, sir! it has definitely cleared my confusion. i am also looking forward to learn more from the other video : ))

[@raghadlibya198]

Thanks alot

[@AhmadRaza-ye9qg]

Sir whats the reason of including only those newborns who r more than 36week gestation. Perinatal asphyxia is more common in preterm infants

[@SridharKs]

I think you mean from cooling point of view. You could extend to 34 weeks and above with caution and after explaining to parents that there is no clear evidence. My dissertation during DM course was on post asphyxial encephalopathy in preterm neonates-published in IJP 2001. The pathology is varied in preterms with different areas affected, less cortical injury. Also, they are at higher risk of being sicker and at risk of multisystem problems from cooling. There may be a gradual progress downwards in gestation as we gain more experience with 34 weekers. I invite others to comment on this too. Thank you for this nice question

[@ugodisemi7975]

Nice video but you were too fast, some of us can't keep up

[@SridharKs]

@@ugodisemi7975 thank you. Please review this. Perinatal asphyxia. An overview of perinatal asphyxia #asphyxia #perinatalasphyxia #birthasphyxia kzbin.info/www/bejne/pYbMnJ5sa8-VmZI

[@SisayNegash]

What is DOC(antibiotics) for PNA, Sir?

[@SridharKs]

If baby has associated infection, your regular first line should be ok. No need for antibiotics specifically for asphyxia unless you are worried about infection

[@AhmadRaza-ye9qg]

Do u use mgso4/phenobarbitol for neuroprotection or just therapeutic hypothermia?

[@SridharKs]

We use mag sulph in imminent preterm for neuroprotection. Not in HIE. Phenobarbitone only for seizures

[@AhmadRaza-ye9qg]

@@SridharKs sir postnatal mgso4?

[@SridharKs]

@@AhmadRaza-ye9qg I have not used

[@hassanfarah9883]

Sir if cord blood is not possible to take, is the peripheral venous blood gases equivalent as cord blood

[@SridharKs]

It won’t be equivalent but you could use that to judge severity of metabolic acidosis if done early enough

[@rydambasnet7706]

very informative presentation . I want to know about selective head cooling and whole body cooling and common setup instruments used for therapeutic hypothermia. Anything for low resource settings !!

[@SridharKs]

Thank you, Rydam. Will plan a video on cooling

[@SridharKs]

There is a video on cooling presented by Dr Kevin Dysart day after tomorrow, do watch

[@misterkhan9324]

Sir u defined..HIE..you mentioned ..that occurs in full term infants... Means Preterms don't suffer from HIE??

[@SridharKs]

Very good question. It is simply better defined in full term babies, as asphyxia in preterm babies is not as clearcut, more varied scenarios and the pattern of injury and outcomes are different. My dissertation while doing DM was on postasphyxial encephalopathy in preterm babies-published (you can look at my researchgate page).

[@misterkhan9324]

@@SridharKs sir where can I make access to it..any link??

[@SridharKs]

@@misterkhan9324 please see all my publications here, you may need to create a free account in researchgate. www.researchgate.net/profile/Sridhar-Kalyanasundaram/publications

[@anishameena666]

Sir, good evening Can u explain Fluid management for AKI in Perinatal Asphyxia baby with AKI developing on Day 1 of life Kindly reply Sir🙏

[@SridharKs]

Hi, like in any situation where reduced perfusion (hypotension, ischemia) lead to renal injury, if there is oligo-anuria, you could still try fluid challenge (with 1 bolus of 10 ml/kg saline), and we should restrict fluids (usually 40 ml/kg/day)-monitor urine output, and a diuretic challenge can be used if no response to above-avoid nephrotoxic drugs (like aminoglycoside)-most babies pass urine and it is rare to have a persistent renal failure in such cases

[@Nadeem-zz1sc]

Sir my child MRI report diffuse cerebral atrophy Bilateral Leukomalacic Chang's subdural effusion Suggestive HIE sequalae stage 2 my baby possible to save his life s please suggestion sir am from India

[@SridharKs]

Sorry to hear that, a lot depends on progress. Do review this and stay positive How do we inform parents that their baby has brain injury? #braininjury #parentupdate #counselling kzbin.info/www/bejne/l4mydJash9yIpLs

[@yohannasaif1673]

U are just doing reading not teaching

[@SridharKs]

Hi, thank you for the feedback. I am not sure if you reviewed the other videos on this channel or just this one. There is a story behind why it was rushed in the beginning 😊Started a live session and after 10 minutes, someone fed back that there was no audio. So I rushed through the slides I already covered!