Category Archives: Neurology

Tip 246: cooling for HIE

A systematic review of several large multi-centre RCTs for therapeutic cooling to treat hypoxic-ischaemic encephalopathy included: Cool Cap (2005, 234 infants, head cooling only); NICHD (2005, 208 infants); TOBY (2009, 325 infants). It showed a statistically significant reduction in the combined … Continue reading

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Tip 245: the TOBY study

The TOBY (TOtal BodY hypothermia for perinatal asphyxial encephalopathy) study used moderate hypothermia (33.5°C for 72 hours) in neonates ≥36/40 with the primary outcome of death or severe disability at 18 months of age. The study did not prove a reduction in either death, … Continue reading

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Tip 239: CFM – severely abnormal

A severely abnormal CFM has: Lower margin < 5 Upper margin < 10 EEG intermittent or low voltage. May have bursts <10. “Burst suppression” Reference: Shah, N. A., & Wusthoff, C. J. (2015). How to use: amplitude-integrated EEG (aEEG). Archives of disease in childhood … Continue reading

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Tip 237: CFM – moderately abnormal

A moderately abnormal CFM has: Lower margin < 5 Upper margin > 10 (may have high amplitude bursts > 25) Discontinuous EEG. Reference: Shah, N. A., & Wusthoff, C. J. (2015). How to use: amplitude-integrated EEG (aEEG). Archives of disease in childhood Education & … Continue reading

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Tip 236: CFM – normal

Normal CFM has: Lower margin > 5 Upper margin > 10 (usually < 50) Sleep wake cycling (raise in lower margin and thus narrower band when awake, cycles over about 20 mins) Continuous EEG Reference: Shah, N. A., & Wusthoff, C. J. … Continue reading

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Tip 235: cerebral function monitoring (CFM)

CFM is more properly known as amplitude-integrated electroencephalography (aEEG). Its use has become common in the management of term babies with HIE and its role is increasing, although the evidence for ‘normality’ is still mostly with term babies. More tips will … Continue reading

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Tip 210: neural tube defects

Despite preconceptual maternal folate supplementation, neural tube defects remain one of the most common congenital CNS defects at 12 per 10,000 live births. External link: BINOCAR (2014), Congenital anomaly statistics 2012 England and Wales, British Isles Network of Congenital Anomaly … Continue reading

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