Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: whole-body cooling versus selective head cooling

Abstract

Objective: Multiorgan dysfunction in asphyxiated newborns receiving therapeutic hypothermia achieved by either selective head cooling (SHC) or whole-body cooling (WBC) has not been well characterized. The beneficial effect of SHC in organs other than the brain may potentially be limited because unlike WBC, SHC aims to achieve effective brain cooling with lesssystemic hypothermia. However, the relative effects of SHC and WBC with currently available cooling protocols on multiorgan dysfunction are unknown.The aim of this study was to compare the multiorgan dysfunction in infants receiving therapeutic hypothermia induced by either SHC or WBC.Study Design: In 59 asphyxiated newborns who received therapeutic hypothermia by either SHC (n ¼ 31) or WBC (n ¼ 28), the severity of pulmonary, hepatic and renal dysfunction and coagulopathy and electrolyte disturbances were assessed before the start of cooling (baseline), and at specific time intervals (24, 48 and 72 h) throughout cooling. Enrollment criteria, clinical monitoring and treatment during cooling, whether SHC or WBC, were similar, as reported earlier.Result: The presence of clinical respiratory distress, along with the need for ventilatory support for varying duration during cooling, was similar in both the WBC and SHC groups (100 vs 94%, P ¼ 0.49, OR 1.9, 95% CI 1.5-2.5). The use of fresh frozen plasma and platelet transfusion to treat coagulopathy and thrombocytopenia was similar (WBC 48% vs SHC 58%, P ¼ 0.59, OR 0.7, 95% CI 0.2-1.9, and WBC 41% vs SHC 32%, P ¼ 0.58, OR 1.4, 95% CI 0.5-4.2, respectively), and equivalent numbers of infants from both groups were treated with vasopressors for >24 h (WBC 59% vs SHC 55%, P ¼ 0.79, OR 1.2, 95% CI 0.4-3.4). The incidence of oliguria (urine output <0.5 ml kg -1 h -1 for >24 h after birth) and rising serum creatinine (with maximum serum creatinine >0.9 mg dl -1 ) was also similar (WBC 18% vs SHC 39%, P ¼ 0.15, OR 0.4, 95% CI 0.1-1.3, and WBC 48% vs SHC 58%, P ¼ 0.59, OR 0.7, 95% CI 0.2-1.9, respectively).Laboratory parameters to assess the differential effect of WBC versus SHC on multiorgan dysfunction during 72 h of cooling, which include serum transaminases (serum aspartate aminotransferase and alanine aminotransferase), prothrombin time, partial thromboplastin time, INR, platelet counts, serum creatinine, serum sodium, serum potassium and serum calcium, were similar between the groups at the initiation of cooling and did not differ with the method of cooling. Conclusion:Multiorgan system dysfunction in asphyxiated newborns during cooling remains similar for both cooling methods. Concerns regarding a differential effect of WBC versus SHC on multiorgan dysfunction, other than of the brain, should not be a consideration in selecting a method to produce therapeutic hypothermia.

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

“…Therapeutic hypothermia, which has become the standard of care for asphyxiated newborns, improves the hypoxic-ischemic lesion on brain MRI (an important proxy predictor for long-term neurodevelopmental outcomes) (12), and presumably also may ameliorate AKI (13,14). Growing evidence in animal models suggest that AKI is not an isolated event but results in remote organ dysfunction involving the heart, lungs, liver, intestines, and brain through an inflammatory mechanism that involves neutrophil migration, cytokine expression, and increased oxidative stress (15).…”

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

“…Necrotizing enterocolitis, hypoglycemia or hemoconcentration was not observed in any baby in the SHC and WBC groups. One of the babies who were applied SHC and one of the babies who were 29 Türk Ped Arş 2015; 50: [27][28][29][30][31][32][33][34][35][36] Atıcı et al Selective head cooling or whole body cooling applied WBC (8%) died in the hospital. There was no significant difference between the two groups in terms of in-hospital mortality (p=0.665).…”

“…It is thought that the neuron protecting effects of cooling are related with reduction of brain metabolism rate, stimulating amino acid release, apoptosis, nitric oxide production, lipid peroxidation and limitation of free radical damage (27). For cooling therapy to create the desired effect it is recommended that cooling be performed as soon as possible following hypoxic ischemic event and initiated in at least 6 hours (4, 28).…”

Terápiás hypothermia alkalmazása az asphyxiás újszülöttek kezelésében – egy hazai neonatológiai centrum eredményei

“…A szervi diszfunkciók előfordulásának tekintetében a teljestest-hűtésben részesülő HIE-s újszülöttek (n = 28) és a szelektív fejhűtésben részesültek (n = 31) közötti összehasonlítást Sarkar és mtsai 2009-ben közölték [34]. Nem találtak szignifikáns különbséget a szervi ká-rosodás mértékében a hűtéses kezelés két típusa között.…”

“…A gépi lélegez-tetés aránya 100%, illetve 94% volt a teljestest-hűtésben részesült, illetve a szelektív fejhűtésben részesültek kö-zött, hasonlóan az általunk kezelt betegcsoporthoz. Az anuria előfordulása 18%-nak, illetve 39%-nak adódott [34], amely többszöröse a betegeinknél észlelt alacsonyabb aránynak (9,3%). A megfigyelés hátterében az áll-hat, hogy diuretikumokat, elsősorban furosemidet gyakrabban alkalmaztunk centrumunkban, bár kétségtelen, hogy a kacsdiuretikumok alkalmazása hypoxia indukálta nephropathiában kérdéses.…”