Dr Peter J Lally

Kariholu U, Montaldo P, Markati T, Lally PJ, Teiserskas J, Liow N, Oliveira V, Soe A, Shankaran S, Thayyil Set al., 2020, Therapeutic hypothermia for mild neonatal encephalopathy: a systematic assessment and meta-evaluation, Archives of disease in Childhood. Fetal and Neonatal edition, Vol: one zero five, Pages: 225-228, ISSN: 1359-2998

aims To examine if therapeutic hypothermia reduces the composite outcome of demise, average or severe incapacity at 18 months or more after gentle neonatal encephalopathy (NE).data supply MEDLINE, Cochrane database, Scopus and ISI net of potential databases, using 'hypoxic ischaemic encephalopathy', 'new child' and 'hypothermia', and 'scientific trials' as scientific field headings and phrases. manual search of the reference lists of all eligible articles and principal assessment articles and further statistics from the corresponding authors of chosen articles.study choice Randomised and quasirandomised managed trials comparing therapeutic hypothermia with typical care.statistics extraction protection and efficacy records extracted independently through two reviewers and analysed.outcomes We included the information on 117 little ones with mild NE inadvertently recruited to 5 cooling trials (two complete-body cooling and three selective head cooling) of reasonable and severe NE, in the meta-analysis. opposed effects came about in 11/56 (19.6%) of the cooled little ones and 12/sixty one (19.7%) of the standard care babies (possibility ratio 1.11 (95% CIs 0.55 to 2.25)).Conclusions latest facts is inadequate to advocate activities therapeutic hypothermia for babies with light encephalopathy and significant benefits or hurt can not be excluded.

Journal article

Montaldo P, Ivain P, Lally P, Bassett P, Pant S, Oliveira V, Mendoza J, Morales M, Swamy R, Shankaran S, Thayyil Set al., 2020, White count number harm after neonatal encephalopathy is associated with thalamic metabolite perturbations, EBioMedicine, Vol: 52, ISSN: 2352-3964

BackgroundAlthough thalamic magnetic resonance (MR) spectroscopy (MRS) precisely predicts hostile results after neonatal encephalopathy, its utility in toddlers with out MR visible deep mind nuclei injury isn't frequent. We examined thalamic MRS metabolite perturbations in encephalopathic babies with white matter (WM) harm with or devoid of cortical injury and its associations with adversarial results.MethodsWe performed a subgroup analysis of all infants recruited to the MARBLE study with isolated WM or combined WM/cortical harm, but no seen harm to the basal ganglia/thalamus (BGT) or posterior limb of the inside pill (PLIC). We used binary logistic regression to verify the affiliation of MRS biomarkers with three consequences (i) WM injury rating (1 vs. 2/3); (ii) cortical injury scores (0/1 vs. 2/3); and (iii) opposed outcomes (described as demise, average/severe incapacity) at two years (sure/no). We also assessed the acc uracy of MRS for predicting opposed effect.FindingsOf the 107 babies included within the analysis, 5 had antagonistic influence. decreased thalamic N-acetylaspartate concentration [NAA] (odds ratio 0.4 (95% CI 0.18–0.93)) and expanded thalamic Lactate/NAA top area ratio (odds ratio 3.37 (95% CI 1.45–7.eighty two)) had been enormously linked to greater WM damage ratings, however no longer with cortical harm. Thalamic [NAA] (≤5.6 mmol/kg/moist weight) had the most fulfilling accuracy for predicting antagonistic results (sensitivity 1.00 (95% CI 0.sixteen–1.00); specificity 0.ninety five (95% CI 0.84–0.99)).InterpretationThalamic NAA is reduced in encephalopathic infants devoid of MR visible deep mind nuclei damage and might be a beneficial predictor of opposed results.FundingThe country wide Institute for health analysis (NIHR).

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Montaldo P, Lally P, Oliveira V, Swamy R, Mendoza J, Atreja G, Kariholu U, Shivamurthappa V, Liow N, Teiserskas J, Pryce R, Soe A, Shankaran S, Thayyil Set al., 2019, Therapeutic hypothermia initiated inside 6 hours of birth is associated with reduced brain injury on MR biomarkers in light hypoxic ischemic encephalopathy: a non-randomised cohort examine, Archives of disorder in Childhood. Fetal and Neonatal edition, Vol: 104, Pages: F515-F520, ISSN: 1359-2998

goal To verify the impact of therapeutic hypothermia on MR biomarkers and neurodevelopmental outcomes in children with mild hypoxic-ischaemic encephalopathy (HIE).Design Non-randomised cohort look at.surroundings Eight tertiary neonatal instruments within the UK and america.patients forty seven infants with gentle HIE on NICHD neurological examination performed within 6 hours after birth.Interventions complete-physique cooling for seventy two hours (n=32) or regular care (n=15; of those 5 have been cooled for <12 hours).main influence measures MRI and MR spectroscopy (MRS) inside 2 weeks after birth, and a neurodevelopmental influence assessment at 2 years.results The baseline qualities in both businesses were similar aside from lower 10 min Apgar rankings (p=0.02) within the cooled toddlers. regardless of this, the mean (SD) thalamic NAA/Cr (1.four (0.1) vs 1.6 (0.2); p<0.001) and NAA/Cho (0.sixty seven (0. 08) vs 0.89 (0.eleven); p<0.001) ratios from MRS had been greatly greater within the cooled group. Cooled children had lower white count damage scores than non-cooled toddlers (p=0.02). four (27%) non-cooled infants with gentle HIE developed seizures after 6 hours of age, while none of the cooled babies developed seizures (p=0.008). Neurodevelopmental outcomes at 2 years had been attainable in 40 (85%) of the babies. adverse outcomes have been seen in 2 (14.3%) non-cooled children, and none of the cooled infants (p=0.09).Conclusions Therapeutic hypothermia may additionally have a neuroprotective impact in little ones with mild HIE, as verified by way of more desirable MRS biomarkers and reduced white remember harm on MRI. This might also warrant extra contrast in correctly powered randomised controlled trials.

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Montaldo P, Swamy R, Bassett P, Lally PJ, Shankaran S, Thayyil Set al., 2019, Pitfalls in using neonatal brain NAA to foretell infant development - Authors' reply., The Lancet Neurology, Vol: 18, Pages: 423-424, ISSN: 1474-4422

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Thayyil S, Liow N, Montaldo P, Lally P, Teiserskas J, Bassett P, Oliveira V, Mendoza J, Slater R, Shankaran Set al., 2019, Pre-emptive morphine throughout therapeutic hypothermia after neonatal encephalopathy: a secondary analysis, Therapeutic Hypothermia and Temperature management, Vol: 10, Pages: forty five-52, ISSN: 2153-7658

besides the fact that children therapeutic hypothermia (TH) improves results after neonatal encephalopathy (NE), the defense and efficacy of preemptive opioid sedation all through cooling remedy is unclear. We carried out a secondary analysis of the records from a huge multicountry prospective observational analyze (Magnetic Resonance Biomarkers in Neonatal Encephalopathy [MARBLE]) to investigate the affiliation of preemptive morphine infusion all through TH on brain damage and neurodevelopmental results after NE. All recruited little ones had 3.0 Tesla magnetic resonance imaging and spectroscopy at 1 week, and neurodevelopmental result assessments at 22 months. Of 223 children recruited to the MARBLE look at, the records on sedation have been available from 169 little ones with moderate (n = a hundred and fifty) or severe NE (n = 19). although the baseline features and admission status have been equivalent, the child ren who bought morphine infusion (n = 141) had been more hypotensive (forty nine% vs. 25%, p = 0.02) and had a enormously longer health facility stay (12 days vs. 9 days, p = 0.009) than folks that didn't (n = 28). Basal ganglia/thalamic injury (ranking ≥1) and cortical harm (rating ≥1) become considered in 34/141 (24%) and 37/141 (26%), respectively, of the morphine community and four/28 (14%) and three/28 (eleven%) of the nonmorphine neighborhood (p > 0.05). On regression modeling adjusted for advantage confounders, preemptive morphine become no longer linked to suggest (general deviation [SD]) thalamic N-acetylaspartate (NAA) attention (6.9 ± 0.9 vs. 6.5 ± 1.5; p = 0.97), and median (interquartile latitude) lactate/NAA peak area ratios (0.sixteen [0.12–0.21] vs. 0.13 [0.11–0.18]; p = 0.20) at 1 week, and imply (SD) Bayley-III composite motor (ninety two ± 23 vs. ninety four ± 10; p = 0.98), language (89 ± 22 vs. 93 ± 

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Lally PJ, Montaldo P, Oliveira V, Soe A, Swamy R, Bassett P, Mendoza J, Atreja G, Kariholu U, Pattnayak S, Sashikumar P, Harizaj H, Mitchell M, Ganesh V, Harigopal S, Dixon J, English P, Clarke P, Muthukumar P, Satodia P, Wayte S, Abernethy LJ, Yajamanyam ok, Bainbridge A, cost D, Huertas A, Sharp DJ, Kalra V, Chawla S, Shankaran S, Thayyil Set al., 2019, Magnetic resonance spectroscopy assessment of mind injury after moderate hypothermia in neonatal encephalopathy: a prospective multi-centre analyze, Lancet Neurology, Vol: 18, Pages: 35-forty five, ISSN: 1474-4422

BackgroundIn neonatal encephalopathy (NE), the clinical manifestations of damage can simplest be reliably assessed a number of years after an intervention, complicating early prognostication and rendering trials of promising neuroprotectants sluggish and high priced. We aimed to examine the accuracy of thalamic proton magnetic resonance spectroscopy (1H MRS) biomarkers as early predictors of the neurodevelopmental abnormalities observed years after NE.MethodsWe conducted a potential multi-centre cohort look at across eight neonatal intensive care units, recruiting time period neonates who received therapeutic hypothermia for NE. We got thalamic 1H MRS 4 to 14 days after delivery, that have been in comparison to medical neurodevelopmental exams performed 18 to 24 months later. The primary endpoint was anabnormal result, defined as death, or moderate or severe incapacity. Receiver working characteristic (ROC) curves were used t o investigate the energy of the connection between selected biomarkers and this outcomes.FindingsWe recruited 223 infants who all underwent MR imaging and spectroscopy at a median (IQR) age of 7 (5 to 10) days, with one hundred ninety (eighty five%) adopted up for neurological examination at a median (IQR) age of 23 (20 to 25) months. Of these followed up, 31 (sixteen%) had moderate or extreme disability, together with one death. The thalamic awareness of Nacetylasparate, [NAA], had a local under the ROC curve (AUC) of 0·ninety nine (ninety five% CI 0·94 to 1·00, n=eighty two), and lactate/NAA peak area ratio had an AUC of 0·ninety four (ninety five% CI 0·89 to 0·ninety seven, n=a hundred and sixty). From time-honored MRI, abnormal signal within the posterior limb of the inside pill (PLIC) gave an AUC of 0·eighty two (95% CI 0·seventy six to 0·87, n=one hundred ninety). Thalamic [NAA] turned into independentlyassociated with neurodevelopmental influence scores on multivaria ble evaluation, and had better prognostic accuracy than regularly occurring MR imaging (98% versus 87%; p<0·001).InterpretationThalamic 1H MRS measures bought quickly after

Journal article

Montaldo P, Kaforou M, Pollara G, Hervás-Maríne D, Calabria I, Panadero J, Pedrola L, Lally PJ, Oliveira V, Kage A, Atreja G, Mendoza J, Soe A, Pattnayak S, Shankaranh S, Vento M, Herberg J, Thayyil Set al., 2019, total blood gene expression reveals specific transcriptome adjustments in neonatal encephalopathy, Neonatology, Vol: one hundred fifteen, Pages: sixty eight-seventy six, ISSN: 1661-7800

BackgroundVariable responses to hypothermic neuroprotection are regarding the clinical heterogeneity of encephalopathic toddlers, therefore stronger ailment stratification may also facilitate the building of individualized neuroprotective treatment options.ObjectivesWe examined if complete blood gene expression evaluation can determine particular transcriptome profiles in neonatal encephalopathy. material and MethodsWe carried out next generation sequencing on entire blood RNA from twelve infants with neonatal encephalopathy, and 6 time-matched healthy time period infants. The vastly differentially expressed genes between encephalopathic and control babies have been recognized. This set of genes turned into then in comparison to the host RNA response in septic neonates and subjected to pathway analysis. ResultsWe identified 950 statistically big genes discriminating completely between the match controls and neonatal encephalo pathy. The most important pathways in neonatal encephalopathy were axonal tips signaling (p =0.0009), granulocyte adhesion and diapedesis (p = 0.003), IL-12 Signaling and production in Macrophages (p= 0.003) and hypoxia-inducible component 1α signaling (p = 0.004). there have been most effective 137 genes in common between neonatal encephalopathy and bacterial sepsis units. ConclusionBabies with neonatal encephalopathy have impressive differences in gene expression profiles compared with healthy manage and septic toddlers. Gene expression profile may well be constructive for sickness stratification based mostly and for establishing customized neuroprotective treatment options.

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Montaldo P, Lally PJ, Oliveira V, Thayyil Set al., 2018, Hypothermic neuroprotection for neonatal encephalopathy in low-and middle-income nations: a new approach to an historic problem, NeoReviews.org, Vol: 19, Pages: e735-e741, ISSN: 1526-9906

Little growth has been made during the last decade in enhancing the outcomes of little ones with neonatal encephalopathy in low-and middle-revenue nations (LMICs), and hundreds of thousands of babies nonetheless die or sustain permanent neurodisability each year. one of the key causes for this lack of progress is a disconnect between encephalopathy analysis in excessive-income nations and LMICs. the vast majority of the neonatal encephalopathy research has been carried out in high-profits nations with a low ailment burden, without the involvement of LMICs. here we focus on how a collaborative method—especially between middle-profits countries and high-income international locations—makes it possible for using state-of-the-paintings magnetic resonance biomarkers and host gene expression profiling for valuable disorder stratification. using the example of the Hypothermia for Encephalopathy in Low-and middle-earnings countri es (HELIX) trial, we describe how this approach may end up in a paradigm shift in world perinatal brain analysis over the subsequent decade.

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Oliveira V, Martins R, Liow N, Teiserskas J, von Rosenberg W, Adjei T, Shivamurthappa V, Lally PJ, Mandic D, Thayyil Set al., 2018, Prognostic accuracy of heart expense variability evaluation in neonatal encephalopathy: a systematic assessment, Neonatology, Vol: a hundred and fifteen, Pages: fifty nine-sixty seven, ISSN: 1661-7800

history: coronary heart price variability analysis presents precise-time quantification of autonomic disturbance after perinatal asphyxia, and might therefore help in disease stratification and prognostication after neonatal encephalopathy (NE). goal: To systematically overview the latest literature on the accuracy of early heart fee variability (HRV) to foretell mind harm and opposed neurodevelopmental results after NE. DESIGN/methods: We systematically searched the literature posted between may also 1947 and may 2018. We protected all prospective and retrospective experiences reporting HRV metrics, within the first 7 days of existence in little ones with NE, and its association with hostile consequences (described as facts of mind damage on magnetic resonance imaging and/or abnormal neurodevelopment at ≥1 12 months of age). We extracted uncooked records wherever feasible to calculate the prognostic indices with self belie f intervals. consequences: We retrieved 379 citations, 5 of which met the criteria. One additional examine became excluded because it analysed an already-protected cohort. The 4 reports offered information on 205 children, 80 (39%) of whom had adversarial outcomes. Prognostic accuracy became reported for 12 distinct HRV metrics and the enviornment under the curve (AUC) assorted between 0.79 and zero.ninety four. The ideal performing metric stated within the protected experiences become the relative energy of excessive-frequency band, with an AUC of 0.ninety four. CONCLUSIONS: HRV metrics are a promising bedside device for early prediction of brain harm and neurodevelopmental influence in little ones with NE. as a result of the small variety of reports purchasable, their heterogeneity and methodological barriers, extra research is required to refine this device so that it can be utilized in medical apply.

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Oliveira V, Kumutha JR E N, Somanna J, Benkappa N, Bandya P, Chandrasekeran M, Swamy R, Mondkar J, Dewang k, Manerkar S, Sundaram M, Chinathambi ok, Bharadwaj S, Bhat V, Madhava V, Nair M, Lally PJ, Montaldo P, Atreja G, Mendoza J, Bassett P, Ramji S, Shankaran S, Thayyil Set al., 2018, Hypothermia for encephalopathy in low-earnings and core-earnings international locations: feasibility of total-physique cooling the use of a reasonably priced servo-managed equipment, BMJ Paediatrics Open, Vol: 2, ISSN: 2399-9772

youngsters therapeutic hypothermia (TH) is the commonplace of look after hypoxic ischaemic encephalopathy in high-profits international locations, the security and efficacy of this remedy in low-income and middle-revenue countries (LMICs) is unknown. We aimed to describe the feasibility of TH the usage of a least expensive servo-managed cooling equipment and the short-term consequences of the cooled children in LMIC. Design: We recruited babies with moderate or severe hypoxic ischaemic encephalopathy (aged <6 hours) admitted to public sector tertiary neonatal instruments in India over a 28-month length. We administered whole-physique cooling (set core temperature 33.5°C) the usage of a servo-managed gadget for seventy two hours, followed via passive rewarming. We collected the records on short-term neonatal outcomes ahead of health center discharge. consequences: Eighty-two toddlers had been included-sixty one (74%) had moderate and 21 (26%) had extreme encephalopathy. imply (SD) hypothermia cooling induction time become 1.7 hour (1.5) and the beneficial cooling time 95% (0.08). The suggest (SD) hypothermia induction time become 1.7 hour (1.5 hour), core temperature all over cooling changed into 33.four°C (0.2), rewarming fee was 0.34°C (0.16°C) per hour and the beneficial cooling time become ninety five% (8%). Twenty-five (fifty one%) children had gastric bleeds, 6 (12%) had pulmonary bleeds and 21 (27%) had meconium on birth. Fifteen (18%) toddlers died before discharge from hospital. heart fee greater than one hundred twenty bpm right through cooling (P=0.01) and gastric bleeds (P<0.001) had been linked to neonatal mortality. Conclusions: The low cost servo-controlled cooling gadget maintained the core temperature neatly inside the target latitude. appropriately powered clinical trials are required to set up the protection and efficacy of TH in LMICs. scientific trial registratio n quantity: NCT01760629.

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Munroe PB, Addison S, Abrams DJ, Sebire NJ, Cartwright J, Donaldson I, Cohen MM, Mein C, Tinker A, Harmer SC, Aziz Q, Terry A, Struebig M, Warren HR, Vadgama B, Fowler DJ, Peebles D, Taylor AM, Lally PJ, Thayyil Set al., 2018, Postmortem genetic checking out for cardiac ion channelopathies in stillbirths, Circulation: Cardiovascular Genetics, Vol: eleven, ISSN: 1942-325X

BackgroundAlthough stillbirth is a significant health issue international, the definitive cause of dying continues to be elusive in lots of circumstances, regardless of targeted post-mortem. during this look at of partly explained and unexplained stillbirths, we used subsequent-era sequencing to check an extended panel of 35 candidate genes established to be linked to ion channel issues and unexpected cardiac death.methods and ResultsWe examined tissue from 242 stillbirths (≥22 weeks), together with these the place no particular explanation for loss of life could be demonstrated after a full autopsy. We acquired high-quality DNA from 70 instances, which have been then sequenced for a customized panel of 35 genes, 12 for inherited long- and brief-QT syndrome genes (LQT1-LQT12 and SQT1-three), and 23 extra candidate genes derived from genome-wide affiliation reviews. We examined the purposeful magnitude of a specific variant by way of patch-clamp electrophysiological recording. No anticipated destructive variations were recognized in KCNQ1 (LQT1) or KCNH2 (LQT2). A infrequent putative pathogenic variant changed into present in KCNJ2(LQT7) in 1 case, and several novel variations of uncertain value had been accompanied. The KCNJ2 variant (p. R40Q), when assessed by whole-mobilephone patch clamp, affected the feature of the channel. There turned into no enormous facts of enrichment of rare estimated destructive variants within any of the candidate genes.ConclusionsAlthough a causative link is doubtful, 1 putative pathogenic and versions of doubtful magnitude variant resulting in cardiac channelopathies turned into recognized in some cases of otherwise unexplained stillbirth, and these variants may also have a task in fetal dying.

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Lally PJ, Montaldo P, Oliveira V, Swamy RS, Soe A, Shankaran S, Thayyil Set al., 2017, Residual brain damage after early discontinuation of cooling remedy in gentle neonatal encephalopathy, Archives of sickness in Childhood. Fetal and Neonatal version, Vol: 103, Pages: F383-F387, ISSN: 1359-2998

We examined the brain damage and neurodevelopmental consequences in a potential cohort of 10 infants with mild encephalopathy who had early cessation of cooling therapy. All babies had MRI and spectroscopy inside 2 weeks after start and neurodevelopmental assessment at 2 years. Cooling was upfront discontinued at a median age of 9 hours (IQR 5-13) due to swift clinical improvement. five (50%) had harm on MRI or spectroscopy, and two (20%) had an abnormal neurodevelopmental result at 2 years. untimely cessation of cooling remedy in little ones with light neonatal encephalopathy does not exclude residual brain damage and adversarial lengthy-term neurodevelopmental outcomes. This look at refers to children recruited into the MARBLE study (NCT01309711, pre-outcomes stage).

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Oliveira V, Singhvi DP, Montaldo P, Lally PJ, Mendoza J, Manerkar S, Shankaran S, Thayyil Set al., 2017, Therapeutic hypothermia in gentle neonatal encephalopathy: a countrywide survey of follow within the UK, Archives of disease in Childhood. Fetal and Neonatal edition, Vol: 103, Pages: F388-F390, ISSN: 1359-2998

besides the fact that children predominant cooling trials (and subsequent guidelines) excluded infants with light encephalopathy, anecdotal evidence suggests that cooling is regularly offered to those children. We record a countrywide survey on current cooling practices for infants with mild encephalopathy in the UK. From 74 neonatal instruments contacted, 68 have been cooling centres. We received 54 responses (seventy nine%) and covered 48 (five excluded due to incomplete records and one discovered later now not to present cooling). of those, 36 centres (75%) offered cooling to little ones with light encephalopathy. although most of the participating contraptions mentioned concentrated on 33-34°C core temperature, seven (19%) regarded initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling just before seventy two hours. babies have been ventilated for cooling in two (6%) instruments and 13 (36%) seda ted all cooled children. Enteral feeding was withheld in 15 (42%) gadgets and decreased below 25% of necessities in eight (22%) units. MRI and neurodevelopmental effect comparison had been provided to all cooled little ones in 29 (80%) and 27 (75%) units, respectively. additional analysis is necessary to make sure ideal neuroprotection in gentle encephalopathy.

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Thayyil S, Oliveira V, Lally PJ, Swamy R, Bassett P, Chandrasekaran M, Mondkar J, Mangalabharathi S, Benkappa N, Seeralar A, Shahidullah M, Montaldo P, Herberg J, Manerkar S, Kumaraswami ok, Kamalaratnam C, Prakash V, Chandramohan R, Bandya P, Mannan MA, Rodrigo R, Nair M, Ramji S, Shankaran S, HELIX Trial groupet al., 2017, Hypothermia for encephalopathy in low and middle-earnings nations (HELIX): analyze protocol for a randomised controlled trial., Trials, Vol: 18, ISSN: 1745-6215

historical past: Therapeutic hypothermia reduces demise and incapacity after reasonable or extreme neonatal encephalopathy in excessive-earnings international locations and is used as common therapy in these settings. youngsters, the protection and efficacy of cooling therapy in low- and core-salary countries (LMICs), where 99% of the disorder burden occurs, continues to be doubtful. we can examine no matter if entire body cooling reduces dying or neurodisability at 18-22 months after neonatal encephalopathy, in LMICs. methods: we can randomly allocate 408 term or near-term infants (aged ≤ 6 h) with average or extreme neonatal encephalopathy admitted to public sector neonatal gadgets in LMIC international locations (India, Bangladesh or Sri Lanka), to both standard care alone or total-body cooling with usual care. little ones allocated to the cooling arm will have core body temperature maintained at 33.5 °C the use of a servo-managed cooling machine for seventy two h, adopted through re-warming at 0.5 °C per hour. All little ones can have exact infection screening at the time of recruitment and 3 Telsa cerebral magnetic resonance imaging and spectroscopy at 1-2 weeks after birth. Our basic endpoint is dying or moderate or extreme incapacity at the age of 18 months. discussion: Upon completion, HELIX should be the biggest cooling trial in neonatal encephalopathy and may provide a definitive reply involving the defense and efficacy of cooling remedy for neonatal encephalopathy in LMICs. The trial will also give important records about the affect of co-existent perinatal an infection on the efficacy of hypothermic neuroprotection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02387385 . Registered on 27 February 2015.

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Cawley P, Few okay, Greenwood R, Malcolm P, Johnson G, Lally P, Thayyil S, Clarke Pet al., 2016, Does magnetic resonance brain scanning at 3.0 Tesla pose a hyperthermic challenge to term neonates?, The Journal of Pediatrics, Vol: 175, Pages: 228-230.e1, ISSN: 0022-3476

next-generation three-Tesla magnetic resonance (MR) scanners offer stronger neonatal neuroimaging, however the more suitable associated radiofrequency radiation may additionally increase the possibility of hyperthermia. security facts for neonatal three-T MR scanning are lacking. We measured rectal temperatures constantly in 25 neonates undergoing three-T brain MR imaging and observed no giant hyperthermic danger.

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Montaldo P, Oliveira V, Lally PJ, Chaban B, Atreja G, Kirmi O, Thayyil Set al., 2016, Therapeutic hypothermia in neonatal cervical backbone harm, Archives of disease in Childhood: Fetal & Neonatal version, Vol: 101, Pages: F468-F468, ISSN: 1468-2052

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Montaldo P, Addison S, Oliveira V, Lally PJ, Taylor AM, Sebire NJ, Thayyil S, Arthurs OJet al., 2016, Quantification of Maceration changes using submit Mortem MRI in Fetuses, BMC medical IMAGING, Vol: sixteen, ISSN: 1471-2342

BackgroundPost mortem imaging is enjoying an increasingly vital function in perinatal autopsy, andcorrect interpretation of imaging adjustments is paramount. here's specially importantfollowing intra-uterine fetal dying, where there can be fetal maceration. The intention of thisstudy become to investigate even if any changes considered on an entire body fetal submit mortemmagnetic resonance imaging (PMMR) correspond to maceration at conventionalautopsy.methods: We performed pre-post-mortem PMMR in seventy five fetuses the usage of a 1.5 Tesla SiemensAvanto MR scanner (Erlangen, Germany). PMMR images had been said blinded to theclinical heritage and post-mortem information using a numerical severity scale (0 = no macerationchanges to 2 = extreme maceration changes) for six distinctive visceral organs (total 12).The diploma of maceration at post-mortem changed into classified based on severity on anumerical scale (1 = no macer ation to four = extreme maceration). We also generatedquantitative maps to measure the liver and lung T2.results: The mean PMMR maceration score correlated neatly with the autopsymaceration ranking (R2=0.ninety three). A PMMR score of ≥ four.5 had a sensitivity of 91%,specificity of 64%, for detecting moderate or extreme maceration at post-mortem. Liver andlung T2 were extended in fetuses with maceration ratings of three-four in assessment tothose with 1-2 (liver p=0.03, lung p=0.02).Conclusions: There turned into a superb correlation between PMMR maceration score and theextent of maceration seen at regularly occurring autopsy. This rating can be helpful ininterpretation of fetal PMMR.

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Lally P, PAULIAH S, MONTALDO P, CHABAN B, Oliveira V, Bainbridge A, Soe A, Pattnayak S, Clarke P, Satodia P, Harigopal S, Abernethy LJ, Turner MA, Huertas Ceballos A, Shankaran S, THAYYIL Set al., 2015, Magnetic Resonance Biomarkers in Neonatal Encephalopathy (MARBLE): A potential Multi-nation study, BMJ Open, Vol: 5, ISSN: 2044-6055

regardless of cooling adverse effects are viewed in upto half of the surviving babies after neonatal encephalopathy. a few novel adjunct drug treatments with cooling have been shown to be particularly neuroprotective in animal reports, and are currently waiting for medical translation. Riggorous comparison of these treatments in part II trials the use of surrogate magnetic resonance biomarkers may speed up thier bench to bedside translation. A fresh systematic evaluate of single centres studies have recommended that Magnetic resonance spectroscopy biomarkers offers the most efficient promise, youngsters the prognostic accuracy of these biomarkers in cooled encephalopathic little ones in a multicentre atmosphere the use of diverse MR scan makes isn't prevalent.

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Ibrahim T, Few okay, Greenwood R, Smith C, Malcolm P, Johnson G, Lally P, Thayyil S, Clarke Pet al., 2015, 'Feed and wrap' or sedate and immobilise for neonatal brain MRI?, ARCHIVES OF disorder IN CHILDHOOD-FETAL AND NEONATAL edition, Vol: 100, Pages: F465-U95, ISSN: 1359-2998

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Soo A, Taha S, Lally P, Kirmi O, Jones B, Thayyil Set al., 2015, evaluation of optic nerve building using put up-mortem Magnetic Resonance Imaging (MRI) in fetuses and newborns, Prenatal diagnosis, Vol: 35, Pages: 1262-1264, ISSN: 0197-3851

What's already accepted about this theme?Biometric reports of fetal orbit and lens development were proven to correlate with gestational age.No accessible records on optic nerve measurements in fetuses/neonates.What does this examine add?normal fetal/neonatal optic nerve diameter measurements for gestational age as measured on post‐mortem MRI scans.

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Arthurs OJ, Thayyil S, Pauliah SS, Jacques TS, Chong WK, Gunny R, Saunders D, Addison S, Lally P, Cady E, Jones R, Norman W, Scott R, Robertson NJ, Wade A, Chitty L, Taylor AM, Sebire NJet al., 2015, Diagnostic accuracy and barriers of put up-mortem MRI for neurological abnormalities in fetuses and children, medical RADIOLOGY, Vol: 70, Pages: 872-880, ISSN: 0009-9260

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Montaldo P, Chaban B, Lally PJ, Sebire NJ, Taylor AM, Thayyil Set al., 2015, Quantification of ante-mortem hypoxic ischemic brain damage by way of put up-mortem cerebral magnetic resonance imaging in neonatal encephalopathy, European Journal of Paediatric Neurology, Vol: 19, Pages: 665-671, ISSN: 1090-3798

put up-mortem (PM) magnetic resonance imaging (MRI) is more and more used as an alternative to general post-mortem in babies dying from neonatal encephalopathy. youngsters, the confounding impact of submit-mortem changes on the detection of ante-mortem ischemic harm is uncertain. We examined even if quantitative MR measurements can accurately distinguish ante-mortem ischemic brain injury from artifacts the use of submit-mortem MRI.methods:We in comparison PM brain MRI (1.5 T Siemens, Avanto) in 7 babies who died with neonatal encephalopathy (NE) of presumed hypoxic-ischemic starting place with 7 new child babies who had sudden unexplained neonatal dying (SUND controls) without proof of hypoxic-ischemic brain harm at autopsy. We measured obvious diffusion coefficients (ADCs), T1-weighted sign depth ratios (SIRs) compared to vitreous humor and T2 leisure times from 19 predefined mind areas customarily involved in neonatal ence phalopathy.outcomes:there have been no changes in imply ADC values, SIRs on T1-weighted photos or T2 rest instances in any of the 19 predefined brain areas between NE and SUND children. All MRI photos confirmed lack of cortical gray/white depend differentiation, loss of the regular excessive signal intensity (SI) within the posterior limb of the inside capsule on T1-weighted photos, and high white depend SI on T2-weighted photos.Conclusion:ordinary put up-mortem changes may be conveniently incorrect for ante-mortem ischemic damage, and present PM MRI quantitative assessment cannot reliably distinguish these. These findings might also have vital implications for appropriate interpretation of PM imaging findings, specifically in medico-felony apply.

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Montaldo P, Pauliah SS, Lally PJ, Olson L, Thayyil Set al., 2015, Cooling in a low-resource atmosphere: misplaced in translation, SEMINARS IN FETAL & NEONATAL drugs, Vol: 20, Pages: 72-seventy nine, ISSN: 1744-165X

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Pauliah S, Lally P, cost D, Bainbridge A, Kurien J, Sivaswami N, Cowan F, Balraj G, Swamy R, Madhavan V, Nair M, Krishnakumar P, Cady E, Shankaran S, Thayyil Set al., 2014, workstation.106 Cerebral damage and Early Childhood Neurodevelopmental outcomes following Neonatal Encephalopathy in a center-income country., Arch Dis newborn Fetal Neonatal Ed, Vol: ninety nine Suppl 1, Pages: A72-A73

however neonatal encephalopathy (NE), bills for 1 million neonatal deaths yearly in low-and core-income nations (LMIC), underlying mind harm and long term results are not smartly characterised in LMIC.

Journal article

Pauliah S, Lally P, Bainbridge A, fee D, Addison S, Cowan F, Satodia P, Wayte S, Soe A, Pattnayak S, Harigopal S, Abernethy LJ, Turner M, Clarke P, Cheong J, Basheer S, Alavi A, Shankaran S, Cady E, Thayyil Set al., 2014, 8.8 Neonatal Encephalopathy in the Cooling remedy period - Preliminary Cerebral Magnetic Resonance effects from the Marble Consortium., Arch Dis child Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A13-A14

despite the fact cerebral metabolic adjustments right through neonatal encephalopathy (NE) have been smartly characterised the use of magnetic resonance spectroscopy (MRS) in single-centre reviews, the frequent impact of therapeutic hypothermia is less clear.

Journal article

Lally P, Pauliah S, price D, Bainbridge A, Addison S, Soe A, Pattnayak S, Satodia P, Wayte S, Ng'andwe E, Clarke P, Johnson G, Harigopal S, English P, Abernethy LJ, Turner M, Cheong J, Shankaran S, Cady E, Thayyil Set al., 2014, laptop.45 Quantification of N-Acetylaspartate concentration in the Neonatal mind: initial consequences from the Multi-Centre Marble look at., Arch Dis infant Fetal Neonatal Ed, Vol: ninety nine Suppl 1

Early cerebral proton magnetic resonance spectroscopy (MRS) predicts medium-term results in neonatal encephalopathy (NE). Metabolite peak-enviornment ratios are most established for prognosis, however conflate pathological information from different metabolites. N-acetylaspartate (NAA) is predominantly neuronal and neuronal loss may still result in reduced NAA absolute-concentration ([NAA]). accordingly, thalamic [NAA] should offer tremendous prognostic cost however is intricate to measure in a scientific setting. we've dependent a protocol for multi-centre [NAA] measurement with the goal to make use of it as a surrogate biomarker in section II clinical trials.

Journal article

Lally P, expense D, Bainbridge A, Pauliah S, Satodia P, Wayte S, Abernethy L, Turner M, Basheer A, Alavi A, Kirmi O, Jones B, Shankaran S, Cady E, Thayyil Set al., 2014, workstation.26 Feasibility of Magnetic Resonance Spectroscopy in analyzing Thalamic Metabolite Concentrations in a Multi-Centre look at of Neonatal Encephalopathy., Arch Dis infant Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A44-A45

Proton magnetic resonance spectroscopy (MRS) has high prognostic value in hypoxic ischaemic encephalopathy (HIE), although its multi-centre software is proscribed by inconsistencies between scanners and protocols. N-acetylaspartate (NAA) is predominantly neuronal: cerebral NAA attention may well be a more reputable HIE-severity biomarker than lactate/NAA.

Journal article

Lally P, Zhang H, Pauliah S, fee D, Bainbridge A, Balraj G, Cady E, Shankaran S, Thayyil Set al., 2014, eight.9 Microstructural changes in Neonatal Encephalopathy printed with the Neurite Orientation Dispersion and Density Imaging (NODDI) mannequin., Arch Dis baby Fetal Neonatal Ed, Vol: 99 Suppl 1

although diffusion tensor imaging (DTI) fractional anisotropy (FA) is regular to quantify neural injury, it's non-selected and littered with a few microstructural adjustments.

Journal article

Addison S, Arthurs O, Lally P, Alavi A, Taylor A, Sebire NJ, Thayyil Set al., 2014, PFM.25 assessment of visceral maceration using publish-mortem magnetic resonance imaging in fetuses., Arch Dis infant Fetal Neonatal Ed, Vol: 99 Suppl 1

publish-mortem magnetic resonance imaging (PM MRI) is more and more used as an choice for perinatal autopsy, however the artefacts related to maceration has no longer been described.

Journal article

Lally P, Arthurs O, Addison S, Alavi A, Sebire NJ, Taylor A, Thayyil Set al., 2014, PFM.33 Estimating Maceration Severity the use of whole body Magnetic Resonance T2 Relaxometry., Arch Dis infant Fetal Neonatal Ed, Vol: ninety nine Suppl 1, Pages: A92-A93

Magnetic resonance (MR) imaging is a great modality to take a look at gross global alterations in tissue constitution, as is existing with maceration. As tissue degrades, its MR transverse relaxation time (T2) should still enhance, with relaxometry strategies enabling quantitative measurement of this.

Journal article

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