Therapeutic hypothermia in neonates — Review of current clinical data, ILCOR recommendations and suggestions for implementation in neonatal intensive care units (original) (raw)
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Optimizing Therapeutic Hypothermia for Neonatal Encephalopathy
PEDIATRICS, 2013
OBJECTIVE: Therapeutic hypothermia (TH) for neonatal encephalopathy is becoming widely available in clinical practice. The goal of this collaborative was to create and implement an evidence-based standard-of-care approach to neonatal encephalopathy, deliver consistent care, and optimize outcomes.
Moderate hypothermia in neonatal encephalopathy: Efficacy outcomes
Pediatric Neurology, 2005
Therapeutic hypothermia holds promise as a rescue neuroprotective strategy for hypoxic-ischemic injury, but the incidence of severe neurologic sequelae with hypothermia is unknown in encephalopathic neonates who present shortly after birth. This study reports a multicenter, randomized, controlled, pilot trial of moderate systemic hypothermia (33°C) vs normothermia (37°C) for 48 hours in neonates initiated within 6 hours of birth or hypoxic-ischemic event. The trial tested the ability to initiate systemic hypothermia in outlying hospitals and participating tertiary care centers, and determined the incidence of adverse neurologic outcomes of death and developmental scores at 12 months by Bayley II or Vineland tests between normothermic and hypothermic groups. Thirty-two hypothermic and 33 normothermic neonates were enrolled. The entry criteria selected a severely affected group of neonates, with 77% Sarnat stage III. Ten hypothermia (10/32, 31%) and 14 normothermia (14/33, 42%) patients expired. Controlling for treatment group, outborn infants were significantly more likely to die than hypoxic-ischemic infants born in participating tertiary care centers (odds ratio 10.7, 95% confidence interval 1.3-90). Severely abnormal motor scores (Psychomotor Development Index < 70) were recorded in 64% of normothermia patients and in 24% of hypothermia patients. The combined outcome of death or severe motor scores yielded fewer bad outcomes in the hypothermia group (52%) than the normothermia group (84%) (P ؍ 0.019). Although these results need to be validated in a large clinical trial, this pilot trial provides important data for clinical trial design of hypothermia treatment in neonatal hypoxic-ischemic injury.
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.
The Lancet, 2005
Nevertheless, early induction of moderate hypothermia in adult patients after cardiac arrest improves neurological recovery, 12,13 and moderate hypothermia is generally safe in an intensive-care setting. 14-18 Our aim was to investigate whether 72 h of selective head cooling with mild systemic hypothermia, 14,17 started within 6 h of birth, improves neurodevelopmental outcome at 18 months in infants with moderate or severe neonatal encephalopathy. Methods This study was done in 25 perinatal centres in accordance with a trial design registered with the US Food and Drug Administration under the investigational device exemption/premarket approval programme. The institutional review board of every centre approved the protocol, and written informed consent was obtained from parents before randomisation. Patients From July, 1999, to January, 2002, we recruited infants born at 36 weeks or longer gestation with acute encephalopathy, with a stepwise protocol consisting of clinical evidence of exposure to perinatal hypoxia
Unanswered questions regarding therapeutic hypothermia for neonates with neonatal encephalopathy
Seminars in Fetal and Neonatal Medicine, 2021
Therapeutic hypothermia (TH) is now well established to improve intact survival after neonatal encephalopathy (NE). However, many questions could not be addressed by the randomized controlled trials. Should late preterm newborns with NE be cooled? Is cooling beneficial for mild NE? Is the current therapeutic time window optimal, or could it be shortened or prolonged? Will either milder or deeper hypothermia be effective? Does infection/inflammation exposure in the perinatal period in combination with NE offer potentially beneficial preconditioning or might it obviate hypothermic neuroprotection? In the present review, we dissect the evidence, for whom, when and how can TH best be delivered, and highlight areas that need further research.
IMPACT OF THERAPEUTIC HYPOTHERMIA IN THE TREATMENT OF NEONATAL ASPHYXIA: A SYSTEMATIC REVIEW OF CLINICAL AND NEUROLOGICAL OUTCOME, 2024
Objective: This study aims to analyze recent evidence on the efficacy, safety and impact of therapeutic hypothermia in the treatment of neonatal asphyxia, highlighting its effect on the clinical and neurological outcomes of newborns. Methodology: A bibliographic review was carried out using the PubMed database, with the descriptors "Perinatal asphyxia", "Neonatal hypoxic-ischemic encephalopathy" and "Birth hypoxia". Of the 461 articles initially found,14 were meticulously selected for detailed analysis. Results: The studies reviewed indicate that therapeutic hypothermia is an effective strategy for preventing hypoxic-ischemic encephalopathy in neonates. This therapy has been shown to significantly reduce adverse neurological events and mortality. Furthermore, factors were identified that can improve clinical interventions, substantially improving the prognosis for patients undergoing this therapy. Final considerations: Induced hypothermia is recognized as an essential preventive treatment for neonatal ischemic encephalopathy. However, the complexity of the topic requires additional studies to elucidate the long-term effects and develop more accurate prognostic tools that guarantee favorable clinical outcomes for this population.