Some like it cool: hypothermia for newborn infants with hypoxic ischemic encephalopathy (original) (raw)
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Whole-Body Hypothermia for Neonates With Hypoxic-Ischemic Encephalopathy
… England Journal of …, 2005
Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain. methods We conducted a randomized trial of hypothermia in infants with a gestational age of at least 36 weeks who were admitted to the hospital at or before six hours of age with either severe acidosis or perinatal complications and resuscitation at birth and who had moderate or severe encephalopathy. Infants were randomly assigned to usual care (control group) or whole-body cooling to an esophageal temperature of 33.5°C for 72 hours, followed by slow rewarming (hypothermia group). Neurodevelopmental outcome was assessed at 18 to 22 months of age. The primary outcome was a combined end point of death or moderate or severe disability. results Of 239 eligible infants, 102 were assigned to the hypothermia group and 106 to the control group. Adverse events were similar in the two groups during the 72 hours of cooling. Primary outcome data were available for 205 infants. Death or moderate or severe disability occurred in 45 of 102 infants (44 percent) in the hypothermia group and 64 of 103 infants (62 percent) in the control group (risk ratio, 0.72; 95 percent confidence interval, 0.54 to 0.95; P=0.01). Twenty-four infants (24 percent) in the hypothermia group and 38 (37 percent) in the control group died (risk ratio, 0.68; 95 percent confidence interval, 0.44 to 1.05; P=0.08). There was no increase in major disability among survivors; the rate of cerebral palsy was 15 of 77 (19 percent) in the hypothermia group as compared with 19 of 64 (30 percent) in the control group (risk ratio, 0.68; 95 percent confidence interval, 0.38 to 1.22; P=0.20). conclusions Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy.
Journal of Neonatal-Perinatal Medicine, 2011
Therapeutic hypothermia has prevented death and brain injury after asphyxiation in 5 randomized trials. Objective: Demonstrate our therapeutic hypothermia program, and compare our results with these randomized trials. Design/Methods: Whole body cooling was performed in 95 infants gestation 36 wks and < 6 hrs of age with severe acidosis, perinatal complications, and/or CPR at birth. Infants were cooled to an esophageal temperature of 33.5 • C for 72 hours, then re-warmed slowly. Results of clinical studies, adverse events, and hospital outcomes are reported. Results: 95 neonates (mean weight 3.43 ± 0.68 SD kg, gestation 39 ± 2 wks) were admitted at ages 4:31 ± 1:10 hrs. Umbilical cord pH ranged 6.43-7.36 (median 6.87). Perinatal sentinel events occurred in 51 subjects. 33/95 infants (35%) presented with clinical seizures; 74/95 infants (78%) are surviving; most are now seizure-free having had improvement of EEG during hypothermia; 19/95 (20%) had normal brain MRI, 52 (55%) had ischemic injuries. 63/74 survivors (85%) are home; 44/74 (60%) are fed orally and passed hearing screens. 30/74 (40%) require tube feedings, and/or have uncertain hearing. 11/74 (15%) were discharged to rehabilitation hospitals. 21 deaths occurred (21/95, 22%): 2 died suddenly on life support while cooling, with no response to CPR. 83% of survivors have been seen in followup; 53% have been seen at ≥9 months. Fifty percent of all followups seen have had normal neurodevelopmental exams. Conclusions: Hypothermia can be instituted safely with mortality and short term morbidity commensurate with 5 previous studies published or otherwise reported. Neurodevelopmental follow up continues.