Name: a piglet model of neonatal hypoxic-ischemic encephalopathy
Uploaded: 2015-05-16T14:00:00
Description: Watch this Scientific Journal Video about A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy at JoVE.com

The authors would like to thank John Kristensen and S&#248;ren Braad Andersen from the Department of Communication, Aarhus University Hospital, Denmark, for their exceptional help with filming and editing. Animal technician Diana Gyldenl&#248;ve and veterinarian Birgitte Kousgaard, Institute of Clinical Medicine Aarhus University Hospital, Denmark for assisting with animal care. This study was supported by the Lundbeck Foundation, the Laerdal Foundation for Acute Medicine, Central Denmark Region&#8217;s Research Foundation, Augustinus Foundation, Aase and Ejnar Danielsens Foundation, the Institute of Clinical Medicine Aarhus University Hospital, Br&#248;drene Hartmanns Foundation, Karen Elise Jensens Foundation, Fonden til L&#230;gevidenskabens Fremme, and Marie Dorthea og Holger From, Haderslevs Fond.

The present protocol was approved by the Danish Animal Experiments Inspectorate. All test animals were anesthetized throughout the procedures. Reproduction of this protocol must be carried out in accordance with national ethics and animal welfare guidelines, and approved by local ethics committees.
1. Animals
<ol>
	<li>Danish Landrace piglets &#60; 24 hr old weighing approximately 1,500 - 2,000 g.</li>
</ol>
2. Anesthesia and Maintenance Fluids
<ol>
	<li>Prepare the...

<ol>
	<li>Chakkarapani, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Xenon+enhances+hypothermic+neuroprotection+in+asphyxiated+newborn+pigs.">Xenon enhances hypothermic neuroprotection in asphyxiated newborn pigs.</a> Annals of. 68, 330-341 (2010).</li><li>Robertson, N. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Melatonin+augments+hypothermic+neuroprotection+in+a+perinatal+asphyxia+model.">Melatonin augments hypothermic neuroprotection in a perinatal asphyxia model.</a> Brain : a journal of neurology. 136, 90-105 (2013).</li><li>Lawn, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Every+Newborn:+progress,+priorities,+and+potential+beyond+survival.">Every Newborn: progress, priorities, and potential beyond survival.</a> Lancet. 384, 189-205 (2014).</li><li>Lee, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intrapartum-related+neonatal+encephalopathy+incidence+and+impairment+at+regional+and+global+levels+for+2010+with+trends+from+1990.">Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990.</a> Pediatric research. 74, 50-72 (2013).</li><li>Kurinczuk, J. J., White-Koning, M., Badawi, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+neonatal+encephalopathy+and+hypoxic-ischaemic+encephalopathy.">Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy.</a> Early human development. 86, 329-338 (2010).</li><li>Shankaran, S., Woldt, E., Koepke, T., Bedard, M. P., Nandyal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+neonatal+morbidity+and+long-term+central+nervous+system+sequelae+of+perinatal+asphyxia+in+term+infants.">Acute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants.</a> Early human development. 25, 135-148 (1991).</li><li>Robertson, C. M., Finer, N. N., Grace, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=School+performance+of+survivors+of+neonatal+encephalopathy+associated+with+birth+asphyxia+at+term.">School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term.</a> The Journal of pediatrics. 114, 753-760 (1989).</li><li>Bennet, L., Booth, L., Gunn, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Potential+biomarkers+for+hypoxic-ischemic+encephalopathy.">Potential biomarkers for hypoxic-ischemic encephalopathy.</a> Seminars in feta., &amp; neonatal medicine. 15, 253-260 (2010).</li><li>Yager, J. Y., Ashwal, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+models+of+perinatal+hypoxic-ischemic+brain+damage.">Animal models of perinatal hypoxic-ischemic brain damage.</a> Pediatric neurology. 40, 156-167 (2009).</li><li>Buckley, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Maturation+of+circulatory+system+in+three+mammalian+models+of+human+development.">Maturation of circulatory system in three mammalian models of human development.</a> Comparative biochemistry and physiology. A, Comparative. 83, 1-7 (1986).</li><li>Dobbing, J., Sands, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+aspects+of+the+brain+growth+spurt.">Comparative aspects of the brain growth spurt.</a> Early human development. 3, 79-83 (1979).</li><li>Dobbing, J., Sands, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+growth+and+development+of+human+brain.">Quantitative growth and development of human brain.</a> Archives of disease in childhood. 48, 757-767 (1973).</li><li>Foster, K. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+improved+survival+model+of+hypoxia/ischaemia+in+the+piglet+suitable+for+neuroprotection+studies.">An improved survival model of hypoxia/ischaemia in the piglet suitable for neuroprotection studies.</a> Brain research. 919, 122-131 (2001).</li><li>LeBlanc, M. H., Li, X. Q., Huang, M., Patel, D. M., Smith, E. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=AMPA+antagonist+LY293558+does+not+affect+the+severity+of+hypoxic-ischemic+injury+in+newborn+pigs.">AMPA antagonist LY293558 does not affect the severity of hypoxic-ischemic injury in newborn pigs.</a> Stroke; a journal of cerebral circulation. 26, 1908-1914 (1995).</li><li>Andresen, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nicotine+affects+the+expression+of+brain-derived+neurotrophic+factor+mRNA+and+protein+in+the+hippocampus+of+hypoxic+newborn+piglets.">Nicotine affects the expression of brain-derived neurotrophic factor mRNA and protein in the hippocampus of hypoxic newborn piglets.</a> J Perinat Med. 37, 553-560 (2009).</li><li>Cheung, P. Y., Gill, R. S., Bigam, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+swine+model+of+neonatal+asphyxia.">A swine model of neonatal asphyxia.</a> Journal of visualized experiments : JoVE. , (2011).</li><li>Thoresen, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+piglet+survival+model+of+posthypoxic+encephalopathy.">A piglet survival model of posthypoxic encephalopathy.</a> Pediatric research. 40, 738-748 (1996).</li><li>Liu, X., Tooley, J., Loberg, E. M., Suleiman, M. S., Thoresen, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+hypothermia+reduces+cardiac+troponin+I+after+hypoxic-ischemic+encephalopathy+in+newborn+pigs.">Immediate hypothermia reduces cardiac troponin I after hypoxic-ischemic encephalopathy in newborn pigs.</a> Pediatric research. 70, 352-356 (2011).</li><li>Bjorkman, S. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hypoxic/Ischemic+models+in+newborn+piglet:+comparison+of+constant+FiO2+versus+variable+FiO2+delivery.">Hypoxic/Ischemic models in newborn piglet: comparison of constant FiO2 versus variable FiO2 delivery.</a> Brain research. 1100, 110-117 (2006).</li><li>Robertson, N. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Which+neuroprotective+agents+are+ready+for+bench+to+bedside+translation+in+the+newborn+infant.">Which neuroprotective agents are ready for bench to bedside translation in the newborn infant.</a> The Journal of pediatrics. 160, 544-552 (2012).</li><li>Jacobs, S. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cooling+for+newborns+with+hypoxic+ischaemic+encephalopathy.">Cooling for newborns with hypoxic ischaemic encephalopathy.</a> Cochrane Database Syst Rev. 1, CD003311 (2013).</li><li>Andresen, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resuscitation+with+21+or+100%+oxygen+in+hypoxic+nicotine-pretreated+newborn+piglets:+possible+neuroprotective+effects+of+nicotine.">Resuscitation with 21 or 100% oxygen in hypoxic nicotine-pretreated newborn piglets: possible neuroprotective effects of nicotine.</a> Neonatology. 93, 36-44 (2008).</li><li>Karlsson, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delayed+hypothermia+as+selective+head+cooling+or+whole+body+cooling+does+not+protect+brain+or+body+in+newborn+pig+subjected+to+hypoxia-ischemia.">Delayed hypothermia as selective head cooling or whole body cooling does not protect brain or body in newborn pig subjected to hypoxia-ischemia.</a> Pediatric research. 64, 74-78 (2008).</li><li>Kovacs, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Asphyxia-induced+release+of+alpha-melanocyte-stimulating+hormone+in+newborn+pigs.">Asphyxia-induced release of alpha-melanocyte-stimulating hormone in newborn pigs.</a> Peptides. 22, 1049-1053 (2001).</li><li>Varvarousi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Asphyxial+cardiac+arrest,+resuscitation+and+neurological+outcome+in+a+Landrace/Large-White+swine+model.">Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/Large-White swine model.</a> Laboratory animals. 45, 184-190 (2011).</li><li>Tammela, O., Pastuszko, A., Lajevardi, N. S., Delivoria-Papadopoulos, M., Wilson, D. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Activity+of+tyrosine+hydroxylase+in+the+striatum+of+newborn+piglets+in+response+to+hypocapnic+hypoxia.">Activity of tyrosine hydroxylase in the striatum of newborn piglets in response to hypocapnic hypoxia.</a> Journal of neurochemistry. 60, 1399-1406 (1993).</li><li>Cote, A., Barter, J., Meehan, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age-dependent+metabolic+effects+of+repeated+hypoxemia+in+piglets.">Age-dependent metabolic effects of repeated hypoxemia in piglets.</a> Canadian journal of physiology and pharmacology. 78, 321-328 (2000).</li><li>Tichauer, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+severity+of+perinatal+hypoxia-ischemia+in+piglets+using+near-infrared+spectroscopy+to+measure+the+cerebral+metabolic+rate+of+oxygen.">Assessing the severity of perinatal hypoxia-ischemia in piglets using near-infrared spectroscopy to measure the cerebral metabolic rate of oxygen.</a> Pediatric research. 65, 301-306 (2009).</li><li>Jasani, M. S., Salzman, S. K., Tice, L. L., Ginn, A., Nadkarni, V. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anesthetic+regimen+effects+on+a+pediatric+porcine+model+of+asphyxial+arrest.">Anesthetic regimen effects on a pediatric porcine model of asphyxial arrest.</a> Resuscitation. 35, 69-75 (1997).</li><li>Chakkarapani, E., Thoresen, M., Liu, X., Walloe, L., Dingley, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Xenon+offers+stable+haemodynamics+independent+of+induced+hypothermia+after+hypoxia-ischaemia+in+newborn+pigs.">Xenon offers stable haemodynamics independent of induced hypothermia after hypoxia-ischaemia in newborn pigs.</a> Intensive care medicine. 38, 316-323 (2012).</li><li>Munkeby, B. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+piglet+model+for+detection+of+hypoxic-ischemic+brain+injury+with+magnetic+resonance+imaging.">A piglet model for detection of hypoxic-ischemic brain injury with magnetic resonance imaging.</a> Acta radiologica. 49, 1049-1057 (2008).</li><li>Andresen, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Newborn+piglets+exposed+to+hypoxia+after+nicotine+or+saline+pretreatment:+long-term+effects+on+brain+and+heart.">Newborn piglets exposed to hypoxia after nicotine or saline pretreatment: long-term effects on brain and heart.</a> J Matern Fetal Neonatal Med. 22, 161-168 (2009).</li><li>Munkeby, B. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resuscitation+with+100%+O2+increases+cerebral+injury+in+hypoxemic+piglets.">Resuscitation with 100% O2 increases cerebral injury in hypoxemic piglets.</a> Pediatric research. 56, 783-790 (2004).</li></ol>

Due to its complexity, the described model can only be implemented in facilities accredited and experienced in animal research. Approval by local ethics committees must be obtained prior to initiation of the experiments, and optimal animal welfare must be ensured at all times. As the model is based on the survival of the test animals, it is important that a sterile environment is maintained during invasive procedures to prevent infections.
The choice of anesthesia is important as most if not a...

Perinatal asphyxia is an acute and frequently unpredicted condition associated with hypoxic-ischemic encephalopathy (HIE). The overall goal of this protocol is to demonstrate a piglet survival model of perinatal hypoxic-ischemic encephalopathy. This model can be used to investigate the effect of various degrees of hypoxia-ischemia on the neonatal brain and of experimental treatments on neuropathology, magnetic resonance imaging and spectroscopy (MRI and MRS) and biomarkers in body fluids such as blood, cerebrospinal fluid and urine. The model has also proven useful for investigating the cardiovascular system, respiratory system, kidney and liver, all of which are affected in global hypoxia-ischemia.
Perinatal asphyxia is the result of compromised oxygen supply intrapartum or in the immediate post-partum period. Intrapartum hypoxic events account for 0.66 million deaths worldwide each year, about a quarter of the world&#8217;s 2.9 million neonatal deaths in 20123. In 2010 1.15 million babies were estimated to have developed neonatal encephalopathy following birth asphyxia4. HIE defined as encephalopathy in infants born after 34 weeks of gestation occurs in 1-3/1,000 live births5 in the industrialized world and up to 8.5/1,000 live births in developing countries4. The risk of death is 10-60%, and the risk of neurological handicap in survivors 30-100%6,7. 50.2 million disability adjusted life years (DALYs) are attributed to intrapartum hypoxic events4. Presently the only treatment other than supportive for HIE is post-hypoxic hypothermia. Thus, advancements in diagnostic procedures and treatment strategies are essential to improve the management of HIE8.
Improvements in the prognosis after perinatal asphyxia and management of neonatal brain injury are based on expanding knowledge of underlying disease mechanisms and possible treatments. Animal models of HIE are particularly useful as different clinical events may lead to HIE and the incidence in any single birth center is low5. An experimental setup in which the influence of biological variation can be minimized, is essential when testing new prognostic and diagnostic tools and treatment strategies. An animal model should approximate the clinical situation as closely as possible, thus contributing to the understanding of the pathological mechanisms underlying the induced injury and the dynamic process involved in the disease and it&#180;s outcome9. Animal models of neonatal HIE have included a number of species, including rodents, lamb, and swine. In comparison, the newborn piglet has higher resemblance to a human newborn with respect to size, cardiovascular system10 and brain maturity at the time of delivery11,12. Monitoring, instrumentation and outcome evaluation in the piglet model is similar to that used in the clinical care of infants with HIE. Accordingly, there is a high degree of translation into newborn care from this model.
Piglets models of perinatal hypoxia and HIE are used by many groups and vary in a number of areas13. According to the purpose of the experiment, careful attention must be paid to the choice of medications, method of inducing hypoxia-ischemia, method of controlling insult duration and severity, post-insult resuscitation and care, and outcome evaluation. To avoid bias a randomized trial design should always be used in interventional studies.
The method applied when inducing hypoxic-ischemic injury is important. Global hypoxia leading to HIE often results in multi-organ failure involving brain, heart, lungs, kidney and liver. Depending on the outcomes evaluated, models of HIE should be based on global hypoxia and ischemia rather than rely on focal ischemia, e.g., by ligation of carotid arteries14. A recent paper applied a combination of hypoxia (FiO2 12%) and carotid artery compression while maintaining mean arterial blood pressure &#62; 40 mm Hg2. Another group induced global hypoxia by 8% O2 until negative base excess &#62; 20 mmol/L or mean arterial blood pressure (MABP) &#60; 15 mm Hg, and sacrificed the animals at 4 hr15. Hypoxia has also been titrated by cardiac output (to 30-40% of baseline), MABP (to 30-35 mm Hg) and arterial pH (6.95-7.05)16.
Models of global hypoxia-ischemia titrated by aEEG suppression similar to the one presented in this report, have demonstrated encephalopathy that is clinically, electrophysiologically, and neuropathologically comparable to the condition found in the asphyxiated term infant17,18.
The degree of HIE induced is essential. A useful animal model of HIE must also allow for testing of new diagnostic procedures and treatment options. To enable this, the models should induce moderate HIE where there is a treatment potential as severe brain injury with little or no treatment potential would be less relevant when evaluating new treatments. Tolerance to hypoxia varies considerably between test animals. Previous studies have shown that a more consistent brain injury can be achieved and that more animals survive17,19 by individualizing the induced hypoxia according to each piglet&#8217;s cerebral response evaluated by amplitude integrated electroencephalography (aEEG) rather than using a set FiO2 value throughout the hypoxic event. The duration of aEEG suppression correlates to the degree of brain injury, with few histopathologic changes at &#60; 20 min aEEG suppression and severe seizures increasing at &#62; 45 min aEEG suppression. A recent review of neuroprotective treatments for HIE identified the need for survival models enabling behavioral outcome measures in animal models20.
There are numerous advantages of the presented HIE piglet model. It is based on a species where results are highly likely to translate to the human physiology. Global hypoxia-ischemia models multi-organ failure and titration of hypoxia-ischemia by aEEG induces a consistent degree of brain injury with survival clinical relevant outcomes such that biomarkers, MRI and behavior may be evaluated at relevant time points.
Piglet models of perinatal asphyxia and HIE have not only contributed significantly to current insight into HIE pathophysiology, but have also successfully preceded clinical trials, ultimately resulting in new treatments in humans. Piglet model studies played a key role in establishing hypothermia as a treatment for HIE21, and are used in neonatal resuscitation research22. Various groups have used piglet models when performing research within asphyxia and HIE, and studies include hypothermia23, alpha-melanocyte-stimulating hormone24, cardiac arrest25, tyrosine hydroxylase activity26, repeated hypoxic exposure27, NMDA receptor activity14, and near-infrared spectroscopy28.
The piglet HIE model presented in this report is technically challenging to work with, as minor adjustments during the course of the procedure may result in either too mild or too severe brain injury29,2. We found that the existing literature lacked sufficient detail to reproduce previously published models. Thus, we here demonstrate each step of the technical procedures necessary for the establishment of a piglet 72 hr survival model in this report, enabling researchers to establish this advanced model for the study of HIE.

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	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:647px;">Warm-touch-pediatric blanket</td>
			<td style="width:211px;">Covidien</td>
			<td style="width:176px;">5030840</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Adhesive Apertrue Drape</td>
			<td>Barrier</td>
			<td>915447</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Utility Drape (sterile) 75x80 cm</td>
			<td>Barrier</td>
			<td>800530</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Neoflon</td>
			<td>BD - Luer</td>
			<td>391350</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:647px;">Laryngoscope</td>
			<td style="width:211px;">Miller</td>
			<td style="width:176px;">85-0045</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Endotracheal tube 2.5 mm&#160;</td>
			<td>Covidien</td>
			<td>111-25</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Endotracheal tube 3.0 mm with cuff</td>
			<td>Unomedical</td>
			<td>MM61110030</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Endotracheal tube 3.5 mm with cuff</td>
			<td>Unomedical</td>
			<td>MM61110035</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:647px;">Anesthesia machine</td>
			<td style="width:211px;">GE Healthcare</td>
			<td style="width:176px;">1009-9002-000</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">EEG - electrodes/disposable subdermal needle electrode</td>
			<td>Cephalon</td>
			<td>ACCE120550</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">ECG - electrodes</td>
			<td>medtronic</td>
			<td>3010107-003</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">ECG-electrodes for MR</td>
			<td>philips</td>
			<td>ACCE120550</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Arterial blood sampler - aspirator</td>
			<td>Radiometer medical ApS</td>
			<td>956552</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Polyurethane Umbilical vein catheter (5 Fr/Ch)</td>
			<td>Covidien</td>
			<td>8888160341</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Polyurethane Umbilical vein catheter (3,5 Fr/ch)</td>
			<td>Covidien</td>
			<td>8888160333</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suture set (size 3-0)</td>
			<td>Covidien</td>
			<td>8886 623341</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">BD Spinal needle 0.7x38mm</td>
			<td>BD needles</td>
			<td>405254</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:647px;">Gas with 96% Nitrogen / 4% oxygen</td>
			<td style="width:211px;">Air Liquide</td>
			<td style="width:176px;">made on order</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:647px;">NeuroMonitor (CFM) system</td>
			<td>Natus Medical Incorporated</td>
			<td>OBM70002</td>
		</tr>
	</tbody>
</table>

a piglet model of neonatal hypoxic-ischemic encephalopathy

Birth asphyxia, which causes hypoxic-ischemic encephalopathy (HIE), accounts for 0.66 million deaths worldwide each year, about a quarter of the world&#8217;s 2.9 million neonatal deaths. Animal models of HIE have contributed to the understanding of the pathophysiology in HIE, and have highlighted the dynamic process that occur in brain injury due to perinatal asphyxia. Thus, animal studies have suggested a time-window for post-insult treatment strategies. Hypothermia has been tested as a treatment for HIE in pdiglet models and subsequently proven effective in clinical trials. Variations of the model have been applied in the study of adjunctive neuroprotective methods and piglet studies of xenon and melatonin have led to clinical phase I and II trials1,2. The piglet HIE model is further used for neonatal resuscitation- and hemodynamic studies as well as in investigations of cerebral hypoxia on a cellular level. However, it is a technically challenging model and variations in the protocol may result in either too mild or too severe brain injury. In this article, we demonstrate the technical procedures necessary for establishing a stable piglet model of neonatal HIE. First, the newborn piglet (&#60; 24 hr old, median weight 1500 g) is anesthetized, intubated, and monitored in a setup comparable to that found in a neonatal intensive care unit. Global hypoxia-ischemia is induced by lowering the inspiratory oxygen fraction to achieve global hypoxia, ischemia through hypotension and a flat trace amplitude integrated EEG (aEEG) indicative of cerebral hypoxia. Survival is promoted by adjusting oxygenation according to the aEEG response and blood pressure. Brain injury is quantified by histopathology and magnetic resonance imaging after 72 hr.

The effects of hypoxia-ischemia on the brain that occur during the induced insult are documented by recording the aEEG trace. A representative aEEG trace is shown in Figure 6.
<img alt="Figure 6" src="/files/ftp_upload/52454/52454fig6.jpg" /> 
Figure 6. Representative aEEG trace. Low amplitude due to hypoxia-ischemia. <a href="https://www.jove.com/files/ftp_upload/52454/52454fig6large.jpg" target="_blank">Please click...

Watch this Scientific Journal Video about A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy at JoVE.com

A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy following perinatal asphyxia can be studied using animal models. We demonstrate the procedures necessary for establishing a piglet model of neonatal hypoxic-ischemic encephalopathy.

Birth asphyxia, which causes hypoxic-ischemic encephalopathy (HIE), accounts for 0.66 million deaths worldwide each year, about a quarter of the ...

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