Effect of rewarming in oxygenation and respiratory condition after neonatal exposure to moderate therapeutic hypothermia

Nitzan, Itamar; Goldberg, Shmuel; Hammerman, Cathy; Bin‐Nun, Alona; Bromiker, Ruben

doi:10.1016/j.pedneo.2018.10.001

Cited by 4 publications

(4 citation statements)

References 17 publications

(21 reference statements)

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“…Of this cohort, 12 neonates had respiratory impairment as shown by higher inspired oxygen requirements or increased desaturations. Of the 18 infants without need for respiratory support, 16 showed a fall in arterial and peripheral oxygen saturation following rewarming 14 . However, in contrast to the present study, no infants in that cohort had new onset need for respiratory support after rewarming.…”

Section: Discussioncontrasting

confidence: 85%

“…Dassios et al reported that arterial oxygen saturation and arterial oxygen tension tended to increase during cooling and decrease at rewarming, albeit this was statistically insignificant, and conversely fractional inspired oxygen increased after rewarming 13 . Of potential concern, decreased oxygenation after rewarming from TH was reported in 28 infants 14 …”

Section: Introductionmentioning

confidence: 99%

“…13 Of potential concern, decreased oxygenation after rewarming from TH was reported in 28 infants. 14 We therefore reviewed a cohort of infants with NE who were treated with TH, to investigate the incidence and characteristics of infants who did not have an oxygen requirement during cooling, then developed new onset oxygen requirement during or after rewarming.…”

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confidence: 99%

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Late onset oxygen requirement following neonatal therapeutic hypothermia

et al. 2020

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Neonatal encephalopathy (NE) affects 1 to 3/1000 term live births each year in developed countries and can lead to death and permanent neurological deficits, such as cerebral palsy and cognitive deficits. 1 Therapeutic hypothermia (TH) is now the standard of care to reduce death and disabilities for infants with moderate to severe NE. 2,3 Infants with NE often require respiratory support for either respiratory morbidities or neurological complications such as reduced consciousness, seizure burden and/or poor respiratory effort. 4-9

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Section: Discussioncontrasting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Late onset oxygen requirement following neonatal therapeutic hypothermia

et al. 2020

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“…Jain et al [115] To evaluate and compare early EEG power and EEG as predictors of MRI injury in neonatal HIE. PLOS ONE PLOS ONE sedation but do not mention the agent used [32,40,[44][45][46], while two studies use generic names such as "opiates" and "benzodiazepines" instead of identifying the specific medication [47,48]. Table 2 lists the different dose ranges of medications used.…”

Section: Prospective Cohort Study N = 44 Questionmentioning

confidence: 99%

Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review

Joshi,

Muneer,

Mbuagbaw

et al. 2023

PLoS ONE

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Background Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress. Objective This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes. Methods We searched the following online databases namely, (i) MEDLINE, (ii) Web of Science, (iii) Cochrane Library, (iv) Scopus, (v) CINAHL, and (vi) EMBASE to identify published original articles between January 2005 and December 2022. We included only English full-text articles on neonates treated with TH and reported the sedation/analgesia strategy used. We excluded articles that reported TH on transport or extracorporeal membrane oxygenation, did not report the intervention strategies for sedation/analgesia, and reported hypoxic-ischemic encephalopathy in which hypothermia was not applied. Results The eligible publications (n = 97) included cohort studies (n = 72), non-randomized experimental studies (n = 2), pharmacokinetic studies (n = 4), dose escalation feasibility trial (n = 1), cross-sectional surveys (n = 5), and randomized control trials (n = 13). Neonatal Pain, Agitation, and Sedation Scale (NPASS) is the most frequently used pain assessment tool in this cohort. The most frequently used pharmacological agents are opioids (Morphine, Fentanyl), benzodiazepine (Midazolam) and Alpha2 agonists (Dexmedetomidine). The proportion of neonates receiving routine sedation-analgesia during TH is center-specific and varies from 40–100% worldwide. TH alters most drugs’ metabolic rate and clearance, except for Midazolam. Dexmedetomidine has additional benefits of thermal tolerance, neuroprotection, faster recovery, and less likelihood of seizures. There is a wide inter-individual variability in serum drug levels due to the impact of temperature, end-organ dysfunction, postnatal age, and body weight on drug metabolism. Conclusions No multidimensional pain scale has been tested for reliability and construct validity in hypothermic encephalopathic neonates. There is an increasing trend towards using routine sedation/analgesia during TH worldwide. Wide variability in the type of medication used, administration (bolus versus infusion), and dose ranges used emphasizes the urgent need for standardized practice recommendations and guidelines. There is insufficient data on the long-term neurological outcomes of exposure to these medications, adjusted for underlying brain injury and severity of encephalopathy. Future studies will need to develop framework tools to enable precise control of sedation/analgesia drug exposure customized to individual patient needs.

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