Un nuovo paradigma neurologico nella terapia intensiva neonatale

In questo articolo Bonifacio e colleghi mettono in luce i progressi della terapia intensiva neonatale per quanto concerne la sopravvivenza dei bambini, sottolineando come questo risultato abbia contemporaneamente portato alla ribalta la morbidità neurologica, cioè il fatto che i bambini che si salvano sono più frequentemente portatori di lesioni neurologiche. L’ipotermia, l’impiego dello Xenon, di antiossidanti ed altri farmaci di volta in volta necessari sembrano fornire un valido contributo nell’abbassare la gravità di queste lesioni. D’altra parte viene sottolineato anche il coinvolgimento delle famiglie e la “marsupio-terapia” (letteralmente tradotta come terapia del canguro).

Abstract. Advances in the care of high-risk newborn babies have contributed to reduced mortality rates for premature and term births, but the surviving neonates often have increased neurological morbidity. Therapies aimed at reducing the neurological sequelae of birth asphyxia at term have brought hypothermia treatment into the realm of standard care. However, this therapy does not provide complete protection from neurological complications and a need to develop adjunctive therapies for improved neurological outcomes remains. In addition, the care of neurologically impaired neonates, regardless of their gestational age, clearly requires a focused approach to avoid further injury to the brain and to optimize the neurodevelopmental status of the newborn baby at discharge from hospital. This focused approach includes, but is not limited to, monitoring of the patient’s brain with amplitude-integrated and continuous video EEG, prevention of infection, developmentally appropriate care, and family support. Provision of dedicated neurocritical care to newborn babies requires a collaborative effort between neonatologists and neurologists, training in neonatal neurology for nurses and future generations of care providers, and the recognition that common neonatal medical problems and intensive care have an effect on the developing brain.

A new neurological focus in neonatal intensive care
Bonifacio SL, Glass HC, Peloquin S, Ferriero DM. Nat Rev Neurol. 2011 Aug 2;7(9):485-94