Publications by authors named "Tai-Wei Wu"
Importance: Outcomes after hypoxic-ischemic encephalopathy (HIE) are variable. Predicting death or severe neurodevelopmental impairment (NDI) in affected neonates is crucial for guiding management and parent communication.
Objective: To predict death or severe NDI in neonates who receive hypothermia for HIE.
Objective: To determine if chorioamnionitis is associated with an increased risk of adverse 2-year outcomes among infants with hypoxic-ischemic encephalopathy (HIE).
Study Design: This cohort study included all infants with moderate to severe HIE treated with therapeutic hypothermia and enrolled on the High-dose Erythropoietin for Asphyxia and Encephalopathy Trial. Clinical chorioamnionitis (CC) was defined as a diagnosis made by a treating obstetrician and histologic chorioamnionitis (HC) was defined as placental inflammation observed on histology.
Background: Both perinatal arterial ischemic stroke (PAIS) and hypoxic-ischemic encephalopathy (HIE) can present with neonatal encephalopathy. We hypothesized that among infants undergoing therapeutic hypothermia, presence of PAIS is associated with a higher risk of seizures and a lower risk of persistent encephalopathy after rewarming.
Methods: We studied 473 infants with moderate or severe HIE enrolled in the HEAL Trial who received a brain MRI.
Article Synopsis
- The study aimed to assess how different international clinical sites manage therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) and identify areas for standardization.
- An electronic survey was conducted, gathering responses from 105 sites, primarily from high-income regions, revealing varying practices in eligibility criteria, use of electroencephalography, and sedation methods.
- The findings indicated significant regional differences in TH management, suggesting that future guidelines should take into account the availability of resources globally.
Article Synopsis
- Infants with hypoxic ischemic encephalopathy (HIE) may have underlying genetic or congenital anomalies, which could influence their health outcomes, but the extent of this impact is not well understood.
- In a study of 500 infants with HIE, 5% were found to have genetic or congenital anomalies; these infants showed higher rates of death or neurodevelopmental impairment (NDI) compared to those without anomalies.
- Despite similar severity of HIE, infants with genetic or congenital issues had worse neurological outcomes, including higher instances of cerebral palsy and lower developmental scores at age two.
Article Synopsis
- The study aimed to compare outcomes in infants with hypoxic-ischemic encephalopathy (HIE) treated with whole-body therapeutic hypothermia (TH) using esophageal vs rectal temperature monitoring.
- Of the 500 infants analyzed, there were no significant differences in rates of death or neurodevelopmental impairment (NDI) between the two monitoring methods.
- However, infants monitored rectally had lower odds of experiencing overcooling and hypotension compared to those monitored esophageally, indicating potential benefits of rectal monitoring.*
Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial.
Arch Dis Child Fetal Neonatal Ed
April 2024
Objective: To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE).
Design: Secondary analysis of the igh-dose rythropoietin for sphyxia and Encephaopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam.
Article Synopsis
- The study aimed to investigate whether the time it takes for infants with hypoxic-ischemic encephalopathy (HIE) to reach a target temperature affects their risk of death or neurodevelopmental impairment (NDI) by the age of 2.
- It involved 500 infants treated with therapeutic hypothermia, categorizing them into early (≤4 hours) and late (>4 hours) target temperature groups, but results showed no significant differences in mortality or NDI between the two groups.
- Ultimately, the findings suggest that the timing of reaching target temperature does not independently impact outcomes, as both groups had similar neurodevelopmental scores among survivors.
Article Synopsis
- - The study aimed to explore how placental abnormalities affect the neurodevelopmental outcomes in newborns with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia, hypothesizing that acute placental issues would lower risks of death or developmental impairments by age 2.
- - Out of 500 newborns with severe HIE, 321 had their placental pathology examined, revealing various types of abnormalities; however, the risk of negative outcomes between those with and without acute placental issues did not show a significant difference.
- - The conclusion indicates that while placental abnormalities did not show a clear link to death or neurodevelopmental impairment in HIE cases, the potential connection between multiple chronic
Objectives: In infants with hypoxic-ischemic encephalopathy (HIE), conflicting information on the association between early glucose homeostasis and outcome exists. We characterized glycemic profiles in the first 12 hours after birth and their association with death and neurodevelopmental impairment (NDI) in neonates with moderate or severe HIE undergoing therapeutic hypothermia.
Methods: This post hoc analysis of the High-dose Erythropoietin for Asphyxia and Encephalopathy trial included n = 491 neonates who had blood glucose (BG) values recorded within 12 hours of birth.
Objective: To determine cerebral glucose concentration and its relationship with glucose infusion rate (GIR) and blood glucose concentration in neonatal encephalopathy during therapeutic hypothermia (TH).
Methods: This was an observational study in which cerebral glucose during TH was quantified by magnetic resonance (MR) spectroscopy and compared with mean blood glucose at the time of scan. Clinical data (gestational age, birth weight, GIR, sedative use) that could affect glucose use were collected.
Importance: Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.
Objective: To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE.
: Myelomeningocele (MMC) causes significant morbidity and mortality. Efforts have been directed to correct this defect . The neuropathology literature on antenatally repaired MMC and associated complications in humans is limited.
View Article and Find Full Text PDFGlioblastoma is the most common primary malignant brain tumor, and median survival is relatively short despite aggressive standard treatment. Natural killer (NK) cell dysfunction is strongly associated with tumor recurrence and metastasis but is unclear in glioblastoma. NK activity (NKA) represents NK cell-secreted interferon-γ (IFN-γ), which modulates immunity and inhibits cancer progression.
View Article and Find Full Text PDFBackground: Neonatal hypoxic-ischemic encephalopathy is an important cause of death as well as long-term disability in survivors. Erythropoietin has been hypothesized to have neuroprotective effects in infants with hypoxic-ischemic encephalopathy, but its effects on neurodevelopmental outcomes when given in conjunction with therapeutic hypothermia are unknown.
Methods: In a multicenter, double-blind, randomized, placebo-controlled trial, we assigned 501 infants born at 36 weeks or more of gestation with moderate or severe hypoxic-ischemic encephalopathy to receive erythropoietin or placebo, in conjunction with standard therapeutic hypothermia.
Article Synopsis
- The study investigates delayed progressive mass effect (DPME) following treatment of ruptured middle cerebral artery (MCA) aneurysms, noting its association with poor clinical outcomes and the possible need for additional surgical intervention.
- Out of 80 patients studied, 27 (33.7%) experienced DPME, which significantly correlated with a higher likelihood of requiring salvage surgery and worse 90-day functional outcomes.
- Independent risk factors for DPME included the presence of hematomas, CTA spot signs, and low-density areas in the perisylvian region, highlighting the importance of monitoring these factors post-operation.
Article Synopsis
- - The study aimed to evaluate the impact of opioid use during therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy on their health outcomes in the hospital.
- - Out of 1,484 infants analyzed, those with high opioid exposure (3-5 days) experienced a longer hospital stay and were less likely to achieve full oral feeding at discharge, while opioid use didn't link to abnormal MRI results.
- - The findings suggest that while opioids may not affect brain imaging results, their potential short-term negative effects need careful consideration during treatment.
Background: Mild hypoxic-ischemic encephalopathy (HIE) is increasingly recognized as a risk factor for neonatal brain injury. We examined the timing and pattern of brain injury in mild HIE.
Methods: This retrospective cohort study includes infants with mild HIE treated at 9 hospitals.
Objective: Decreased selective motor control limits gait function of children with spastic cerebral palsy (CP). Infants at high risk of CP demonstrate decreased selective motor control by 1 month of age. To motivate more selective hip-knee control, infants at high risk of CP participated in an in-home kicking-activated mobile task.
View Article and Find Full Text PDFNeonates with mild hypoxic-ischaemic encephalopathy receiving supportive care versus therapeutic hypothermia in California.
Arch Dis Child Fetal Neonatal Ed
May 2022
Objective: The use of therapeutic hypothermia (TH) for mild hypoxic-ischaemic encephalopathy (HIE) remains controversial and inconsistent. We analysed trends in TH and maternal and infant characteristics associated with short-term outcomes of infants with mild HIE.
Design: Retrospective cohort analysis of the California Perinatal Quality Care Collaborative database 2010-2018.
Article Synopsis
- The study aimed to explore how often placental abnormalities occur in newborns with hypoxic-ischemic encephalopathy (HIE) and how these abnormalities relate to the severity of HIE symptoms.
- Researchers examined 500 infants with moderate to severe HIE, finding that 85% had some form of placental abnormality, particularly in those born at or beyond 40 weeks of gestation.
- The presence of placental issues, both acute and chronic, was linked to more severe clinical outcomes, highlighting the intricate connections between placental health and HIE development.
Article Synopsis
- Researchers identified a founder mutation involving a 2870 bp deletion and 9 bp insertion in the angiotensinogen gene, linked to a severe form of autosomal recessive renal tubular dysgenesis (ARRTD).
- High-dose hydrocortisone therapy was effective in one patient, boosting levels of angiotensinogen and its components, which led to a significant clinical improvement.
- The study suggests that the truncated angiotensinogen protein resulting from the mutation has lower stability and interaction with renin, and hydrocortisone may enhance its stability and therapeutic potential by improving this interaction.
Article Synopsis
- Hemodynamic compromise in neonates can arise from several conditions including transitional period maladaptation, sepsis, congenital heart issues, and dehydration, making management challenging.
- Despite advances in neonatal care, treatment often relies on the clinician's experience due to a lack of strong evidence-based guidelines.
- The article emphasizes the growing need for thorough hemodynamic assessments and explores new techniques like functional echocardiography and impedance-based cardiometry to improve management strategies for affected infants.
Article Synopsis
- The study aimed to create predictive models for death or neurodevelopmental impairment (NDI) in infants with neonatal hypoxic-ischemic encephalopathy (HIE) based on data collected at the time of NICU admission and discharge.
- It analyzed a cohort of infants treated with therapeutic hypothermia from the Children's Hospitals Neonatal Consortium Database, identifying significant factors like HIE severity and certain treatments that were associated with outcomes.
- The predictive models developed demonstrated good accuracy, with the potential to help clinicians assess risk levels better and tailor early interventions for infants most at risk of negative outcomes.*