Selective head cooling and whole body cooling as neuroprotective agents in severe perinatal asphyxia

Abstract

SUMMARY INTRODUCTION The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Studies designed around this fact have shown that moderate cerebral hypothermia, initiated as early as possible, has been associated with potent, long-lasting neuroprotection in perinatal patients. OBJECTIVES To review the benefits of hypothermia in improving cellular function, based on the cellular characteristics of hypoxic-ischemic cerebral injury and compare the results of two different methods of cooling the brain parenchyma. METHODS Medline, Lilacs, Scielo, and PubMed were searched for articles registered between 1990 and 2019 in Portuguese and English, focused on trials comparing the safety and effectiveness of total body cooling with selective head cooling with HIE. RESULTS We found that full-body cooling provides homogenous cooling to all brain structures, including the peripheral and central regions of the brain. Selective head cooling provides a more extensive cooling to the cortical region of the brain than to the central structures. CONCLUSIONS Both methods demonstrated to have neuroprotective properties, although full-body cooling provides a broader area of protection. Recently, head cooling combined with some body cooling has been applied, which is the most promising approach. The challenge for the future is to find ways of improving the effectiveness of the treatment.

Serelaxin activates eNOS, suppresses inflammation, attenuates developmental delay and improves cognitive functions of neonatal rats after germinal matrix hemorrhage

“…It is important to mention, that hypothermia is able to significantly attenuate the development of neonatal brain injury both in humans and in pre-clinical models 21,22 . In fact, hypothermia has become standard clinical treatment after perinatal asphyxia 23 . Therefore, the monitoring of body temperature is important in this model and the body temperature was continually controlled throughout the whole surgery.…”

Immunomodulatory Mechanism and Potential Therapies for Perinatal Hypoxic-Ischemic Brain Damage

“…It can also reduce the infiltration of inflammatory cells in the brain and reduce the release of inflammatory factors (Gu, 2014), thus protecting brain tissue. However, in both instances, the time window is very narrow and limited; treatments need to be started within 6 h after birth when neurological damage symptoms are rarely detected and HIBD diagnosis is hard to make (Jacobs, 2007;Nonato, 2019). In view of this limitation and time constraints, more effective interventions are urgently needed to help improve the prognosis of children with HIBD.…”

Comparação entre resfriamento seletivo da cabeça e resfriamento de corpo inteiro na hipotermia terapêutica neonatal

“…The hypoxic-ischemic encephalopathy (HIE) is one of the most alarming conditions in newborns worldwide, with an incidence ranging from 2 to 6 per 1,000 live births, being higher in less developed countries 1 . In Brazil, it is the second cause of neonatal mortality when considering the first day or the first week of life 2 . HIE leads to death in 60% of affected infants 3 , with at least 25% of survivors having long-term neurological sequelae 2,4 .…”