Therapeutic Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy (original) (raw)
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Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy
Archives of Pediatrics & Adolescent Medicine, 2012
Objective: To establish the evidence of therapeutic hypothermia for newborns with hypoxic ischemic encephalopathy (HIE). Data Sources: Cochrane Central Register of Controlled Trials, Oxford Database of Perinatal Trials, MEDLINE, EMBASE, and previous reviews. Study Selection: Randomized controlled trials that compared therapeutic hypothermia to normothermia for newborns with HIE. Intervention: Therapeutic hypothermia. Main Outcome Measures: Death or major neurodevelopmental disability at 18 months.
Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy
Archives of Pediatrics & Adolescent Medicine, 2007
To systematically review the effectiveness, as determined by survival without moderate to severe neurodevelopmental disability in infancy and childhood, and the safety of hypothermia vs normothermia in neonates with postintrapartum hypoxic-ischemic encephalopathy and to perform subgroup analyses based on severity of encephalopathy (moderate or severe), type of hypothermia (systemic or selective head cooling), and degree of hypothermia (moderate [Յ32.0-33.5°C] or mild [Ն33.6°C]). Data Sources: MEDLINE, EMBASE, CINAHL (Cumulative Index for Nursing and Allied Health Literature), the Cochrane Library, abstracts of annual meetings of the Pediatric Academic Societies, and bibliographies of identified articles. Study Selection: Randomized and quasi-randomized controlled trials without language restriction were assessed by 2 reviewers independently and discrepancies were resolved by involving a third reviewer. Quality of the trials was assessed on the basis of concealment of allocation, method of randomization, masking of outcome assessment, and completeness of follow-up. Intervention: Systemic or selective head hypothermia compared with normothermia. Main Outcome Measure: Death or moderate to severe neurodevelopmental disability. Results: Eight studies of acceptable quality were included. The combined outcome of death or neurodevelopmental disability in childhood was reduced in infants receiving hypothermia compared with control infants (4 studies including 497 infants; relative risk, 0.76, 95% confidence interval, 0.65-0.88; number needed to treat, 6; 95% confidence interval, 4-14), as were death and moderate to severe neurodevelopmental disability when analyzed separately. Cardiac arrhythmias and thrombocytopenia were more common with hypothermia; however, they were clinically benign. Conclusions: In neonates with postintrapartum asphyxial hypoxic-ischemic encephalopathy, hypothermia is effective in reducing death and moderate to severe neurodevelopmental disability either in combination or separately and is a safe intervention.
Therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy
Early Human Development, 2010
There is now a strong evidence base supporting therapeutic hypothermia for infants with moderate or severe neonatal hypoxic ischaemic encephalopathy. Experimental and clinical data indicate that induced hypothermia reduces cerebral hypoxic ischaemic injury and randomized clinical trials in newborns with hypoxic ischaemic encephalopathy confirm improved neurological outcomes and survival at 18 months of age with therapeutic hypothermia. Studies are ongoing to confirm whether these benefits are maintained in later childhood. Efforts are now focused on optimal implementation of therapeutic hypothermia in clinical practice: training in the assessment of severity of encephalopathy; initiation and maintenance of hypothermia before admission to a cooling facility; care of the infant during cooling; and appropriate investigation and follow-up are crucial for optimizing neurological outcomes. The establishment of registries of infants with hypoxic ischaemic encephalopathy and audit are important for guiding clinical practice.
Therapeutic Hypothermia in Neonatal Hypoxic-Ischemic Encephalopathy
Current Neurology and Neuroscience Reports, 2019
Purpose of review-therapeutic hypothermia reduces death or disability in term and near-term infants with moderate-severe hypoxic-ischemic encephalopathy. Nevertheless, many infants still survive with disability, despite hypothermia, supporting further research into ways to further improve neurologic outcomes. Recent findings-recent clinical and experimental studies have refined our understanding of the key parameters for hypothermic neuroprotection, including timing of initiation, depth, and duration of hypothermia, and subsequent rewarming rate. However, important knowledge gaps remain. There is encouraging clinical evidence from a small phase II trial that combined treatment of hypothermia with recombinant erythropoietin further reduces risk of disability but definitive studies are still needed. Summary-In conclusion, recent studies suggest that current protocols for therapeutic hypothermia are nearoptimal, and that the key to better neurodevelopmental outcomes is earlier diagnosis and initiation of hypothermia after birth. Further research is essential to find and evaluate ways to further improve outcomes after hypoxic-ischemic encephalopathy, including add-on therapies for therapeutic hypothermia and preventing pyrexia during labor and delivery.
Therapeutic hypothermia for neonates with hypoxic ischemic encephalopathy
Pediatrics & Neonatology, 2017
Therapeutic hypothermia (TH) is a recommended regimen for newborn infants who are at or near term with evolving moderate-to-severe hypoxic ischemic encephalopathy (HIE). The Task Force of the Taiwan Child Neurology Society and the Taiwan Society of Neonatology held a joint meeting in 2015 to establish recommendations for using TH on newborn patients with HIE. Based on current evidence and experts' experiences, this review article summarizes the key points and recommendations regarding TH for newborns with HIE, including: (1) selection criteria for TH, (2) choices of method and equipment for TH, (3) TH before and during transport, (4) methods for temperature maintenance, monitoring, and rewarming, (5) systemic care of patients during TH, including the care of respiratory and cardiovascular systems, management of fluids, electrolytes, and nutrition, as well as sedation and drug metabolism, (6) monitoring and management of seizures, (7) neuroimaging, prognostic factors, and outcomes, and (8) adjuvant therapy for TH.
Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy: Systematic Review
Obstetrical & Gynecological Survey, 2008
To systematically review the effectiveness, as determined by survival without moderate to severe neurodevelopmental disability in infancy and childhood, and the safety of hypothermia vs normothermia in neonates with postintrapartum hypoxic-ischemic encephalopathy and to perform subgroup analyses based on severity of encephalopathy (moderate or severe), type of hypothermia (systemic or selective head cooling), and degree of hypothermia (moderate [Յ32.0-33.5°C] or mild [Ն33.6°C]). Data Sources: MEDLINE, EMBASE, CINAHL (Cumulative Index for Nursing and Allied Health Literature), the Cochrane Library, abstracts of annual meetings of the Pediatric Academic Societies, and bibliographies of identified articles. Study Selection: Randomized and quasi-randomized controlled trials without language restriction were assessed by 2 reviewers independently and discrepancies were resolved by involving a third reviewer. Quality of the trials was assessed on the basis of concealment of allocation, method of randomization, masking of outcome assessment, and completeness of follow-up. Intervention: Systemic or selective head hypothermia compared with normothermia. Main Outcome Measure: Death or moderate to severe neurodevelopmental disability. Results: Eight studies of acceptable quality were included. The combined outcome of death or neurodevelopmental disability in childhood was reduced in infants receiving hypothermia compared with control infants (4 studies including 497 infants; relative risk, 0.76, 95% confidence interval, 0.65-0.88; number needed to treat, 6; 95% confidence interval, 4-14), as were death and moderate to severe neurodevelopmental disability when analyzed separately. Cardiac arrhythmias and thrombocytopenia were more common with hypothermia; however, they were clinically benign. Conclusions: In neonates with postintrapartum asphyxial hypoxic-ischemic encephalopathy, hypothermia is effective in reducing death and moderate to severe neurodevelopmental disability either in combination or separately and is a safe intervention.
Use of therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy: a literature review (Atena Editora), 2023
Objectives: Expose basic concepts of the existing literature on induced hypothermia in newborns who evolved with hypoxic-ischemic encephalopathy. Methods: A narrative literature review was carried out based on 22 articles, from February to April 2023, prioritizing articles published in the last 5 years. The articles were taken from the Lilacs, Pubmed, Scielo, Embase and Scopus databases. Results: Hypoxic-ischemic encephalopathy (HIE) consists of a series of cellular and molecular alterations resulting from a severe anoxic brain injury that occurred in the neonatal period. Current research reveals that even the condition in its mild form is not benign. Therapeutic Hypothermia (TH) is the most effective technique indicated for the management of newborns (NB) admitted to the Neonatal Intensive Care Unit (NICU) who present neuropathies secondary to asphyxia, accompanied by clinical signs of Hypoxic-Ischemic Encephalopathy. The therapy consists of exposing the newborn at term or late preterm to a temperature of 33.5º C from the first 6 hours of life and, over 72 hours of cooling, gradually rewarming the patient. Total body hypothermia, when compared with the control group to identify the outcome of neurological abnormalities, contributed to a 17% reduction. Concomitantly with these data, found at 18 months of age, there was also a 21% reduction in the risk of cerebral palsy and a 22% reduction in moderate or severe disability. Conclusion: It has been shown that induced hypothermia can be effective in reducing mortality and neurodevelopmental failures in these newborns.
Treatment of Neonatal Hypoxic Ischemic Encephalopathy with Hypothermia; the Window of Opportunity
Perinatal hypoxic-ischemic encephalopathy (HIE) is a common cause of brain damage and death in the newborn period. HIE occurs as a result of an injury to the brain from a combination of systemic hypoxemia; which refers to an arterial concentration of oxygen that is less than normal; and diminished cerebral perfusion that leads to ischemia or insufficient blood flow to the cells to maintain their normal function. The pathogenesis involves a sequence of cerebral insults that occur initially with hypoxemia, ischemia and next by oxygenation and reperfusion of the ischemic tissue. HIE may cause multi-system organ damage with significant aberrations in clotting, renal, and cardiac functions. The incidence of HIE is 2-6 per 1,000 live birth and it appears to be much higher in the developing countries. It may occur as a result of prepartum, intrapartum, or perinatal causes, and is most commonly seen in full-term or post-term infants. Prenatal-intrapartum risk factors include fetal distress,...