Therapeutic hypothermia in asphyxiated neonates with hypoxic-ischemic encephalopathy: A single-center experience from its first application in Greece (original) (raw)
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Journal of Medical Science And clinical Research, 2016
Background/ Objective: Therapeutic hypothermia has become an accepted therapy in asphyxiated newborns with evidence of moderate to severe hypoxic-ischemic encephalopathy. In this study, it has been described our new experience with the whole body cooling treatment method in asphyxiated neonates. To our knowledge, this is the first relevant report in Saudi Arabia. Methods: The medical records of all asphyxiated neonates treated with therapeutic hypothermia in Makkah Maternity children hospital between 2013-2015 were retrospectively reviewed. We recorded data related to neonatal-perinatal characteristics, total body cooling method was performed and outcomes. Results: One hundred and forty asphyxiated neonates [median gestational age 38 weeks ] received total body cooling (rectal temperature 33.5 ± 0.5 o C for 72 hours followed by slow re-worming) during the study period for moderate and severe hypoxic-ischemic encephalopathy. All neonates were depressed upon delivery with median Apgar scores 6 at 10 minutes. Therapeutic hypothermia was initiated at the median age of 6 hours after birth. On follow-up after our cooling method, neurodevelopment outcome was normal in 107 and 83 cases, depending on the evidence of computerized axial tomography (CAT) scan and the absence of clinical seizures after our cooling treatment method. Conclusions: Our initial experience with total body cooling treatment method supports its beneficial effect as safe and effective in asphyxiated newborns. This treatment should be offered in all centers involved in the care of such neonates using our simple method.
Ginekologia Polska, 2019
Objectives: Therapeutic hypothermia TH became broadly used in the management of the asphyxiated newborns. Although two cooling methods are used, so far the superiority of none of them has been established. The purpose of the study is to compare two cooling methods: selective head cooling (SHC) and whole body cooling (WBC) Material and methods: We conducted a prospective observational study in newborns with HIE. The patients received one of methods: SHC or WBC. The eligibility criteria were similar to previous studies. Stability of cardio-respiratory parameters and short term outcomes were analyzed. Results: 78 neonates with hypoxic-ischemic encephalopathy due to perinatal asphyxia were involved in this study. The SHC group consisted of 51 newborns, the WBC group consisted of 27 patients. Both study groups had similar baseline characteristics and condition at birth. There were no significant differences in hospital course, neurological status and adverse effects associated with cooling procedure between groups. Analyzing the rate of thrombocytopenia and the number of transfusions of blood components no statistically significant differences were found between the groups. Conclusions: Results of our study indicate that two compared methods of TH despite varied target core temperature ranges do not differ significantly according to clinical course and risk of adverse events. Further observations are conducted and we look forward to the results of the long neurodevelopmental care.
Sao Paulo Medical Journal, 2014
CONTEXT AND OBJECTIVE:Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that therapeutic hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns.DESIGN AND SETTING:Retrospective study, conducted in a university hospital.METHODS:Thirty-five patients with perinatal asphyxia undergoing body cooling between May 2009 and November 2012 were evaluated.RESULTS:Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The main complication was infection, diagnosed in seven mothers (20%) and 14 newborns (40%). Convulsions occurred in 15 infants (43%). Thirty-one patients (88.6%) required mechanical ventilation and 14 of them (45%) were ex...
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.
Therapeutic Hypothermia for Management of Neonatal Asphyxia: What Nurses Need to Know
Critical Care Nurse, 2011
Birth asphyxia can induce a cascade of reactions that result in altered brain function known as hypoxic-ischemic encephalopathy. Possible outcomes for survivors of birth asphyxia vary widely, from a normal outcome to death, with a wide range of disabilities in between, including long-term neurodevelopmental disability, cerebral palsy, neuromotor delay, and developmental delay. Treatment of hypoxic-ischemic encephalopathy has centered on dampening or blocking the biochemical pathways that lead to death of neuronal cells. The reduction of body temperature by 3ºC to 5ºC less than normal body temperature can reduce cerebral injury. At Mount Sinai Hospital in Toronto, Ontario, the goal of therapeutic hypothermia is to achieve a rectal temperature of 33ºC to 34ºC, and the protocol is started within 6 hours after birth. The hypothermia is maintained for 72 hours, and then the infant is gradually warmed to normal body temperature (36.8ºC–37ºC). The protocol and nursing implications are pres...
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2008
Background This is a phase 4 study of infants registered with the UK TOBY Cooling Register from December 2006 to February 2008. The registry was established on completion of enrolment to the TOBY randomised trial of treatment with whole body hypothermia following perinatal asphyxia at the end of November 2006. Methods We collected information about patient characteristics, condition at birth, resuscitation details, severity of encephalopathy, hourly temperature record, clinical complications and outcomes before discharge from hospital. Results 120 infants born at median 40 (IQR 38, 41) weeks' gestation and weighing median 3287 (IQR 2895, 3710) grams at birth were studied. Cooling was started at median 3 h 54 min (IQR 2 h, 5 h 32 min) after birth. All but three infants underwent whole body cooling. The mean (SD) rectal temperature from 6 to 72 hours of the period of cooling was 33.57 o C (0.51 o C). The daily encephalopathy score fell: median (IQR) 11 (6, 15), 9.7 (5, 14), 8 (5, 13) and 7 (2, 12) on each of days 1-4 after birth. 51% of the infants established full oral feeding at a median (range) of 9 (4-24) days. 26% of the study infants died. MRI was consistent with hypoxia-ischaemia in most cases. Clinical complications were not considered due to hypothermia. Conclusion In the UK, therapeutic hypothermia following perinatal asphyxia is increasingly being provided. The target body temperature is successfully achieved and the clinical complications observed were not attributed to hypothermia. Treatment with hypothermia may have prevented the worsening of encephalopathy that is commonly observed following asphyxia.
The use of hypothermia: a role in the treatment of neonatal asphyxia?
Pediatric Neurology, 1999
Perinatal asphyxia remains one of the most devastating neurologic processes. Although the understanding of the pathophysiology after perinatal asphyxia is extensive, there are few therapeutic interventions available to prevent or even mitigate the devastating process that unfolds after injury. The search for a safe and efficacious therapy has prompted scientists and clinicians to consider various promising therapies. One such therapy is therapeutic hypothermia. On the basis of adult, pediatric, and animal research, there is increasing evidence to suggest that therapeutic hypothermia may be an effective intervention to lessen the secondary neuronal injury that ensues after a hypoxic-ischemic insult. In this article the historic and modern-day uses of therapeutic hypothermia are first reviewed. The pathophysiology of neonatal asphyxia is examined next, with emphasis on the changes that occur when therapeutic hypothermia is implemented. Potential side-effects of the therapy in the neonate and the debate over systemic vs selective hypothermia are discussed. Lastly, although hypothermia as a potential treatment modality for neonates with hypoxic-ischemic encephalopathy is supported by numerous studies, the need for well-designed multicenter trials with detailed patient entry criteria and therapeutic conditions is emphasized.
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.