Eligibility criteria for therapeutic hypothermia: From trials to clinical practice

Mehta, Shailender; Joshi, Anjali; Bajuk, Barbara; Badawi, Nadia; McIntyre, Sarah; Lui, Kei

doi:10.1111/jpc.13378

Cited by 32 publications

(19 citation statements)

References 43 publications

(58 reference statements)

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“…The treatment protocols including hypothermia, exchange transfusion, antiepileptic drugs, and symptomatic support were in keeping with the criteria of expert consensus on the clinical diagnosis and treatment of corresponding clinical symptoms in China. The criteria for whole‐body hypothermia were (1) an Apgar score ≤3 at 1 min or ≤5 at 5 min or continued need for resuscitation, (2) an umbilical cord blood or arterial blood pH < 7.0 within 1 h after birth or a base deficit >16 mmol/L, and (3) assessed with moderate/severe HIE or abnormal aEEG. Whole‐body hypothermia was initiated within 12 h of age using a cooling mattress.…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

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Objective To determine the efficacy and the prognostic value of amplitude‐integrated electroencephalography (aEEG) in term and near‐term neonates with high risk of neurological sequelae. Methods Infants of ≥35 weeks of gestation diagnosed with neonatal encephalopathy or with high risk of brain injury were included. All eligible infants underwent aEEG within 6 h after clinical assessment. The infants were followed up 12 months to evaluate neurological development. Results A total of 250 infants were eligible, of which 85 had normal aEEG, 81 had mildly abnormal aEEG, and 84 had severely abnormal aEEG. Of these infants, 168 were diagnosed with different neonatal encephalopathies, 27 with congenital or metabolic diseases, and 55 with high risk of brain injury. In all, 22 infants died, 19 were lost to follow‐up, and 209 completed the follow‐up at 12 months, of which 62 were diagnosed with a neurological disability. Statistical analysis showed that severely abnormal aEEG predicted adverse neurological outcome with a sensitivity of 70.2%, a specificity of 87.1%, a positive predictive value of 75.6%, and a negative predictive value of 83.7%. Interpretation aEEG can predict adverse outcomes in high‐risk neonates and is a useful method for monitoring neonates with high risk of adverse neurological outcomes.

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Section: Methodsmentioning

confidence: 99%

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

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“…Although National Institute of Clinical Excellence recommends cooling treatment only for term infants who suffer moderate or severe neonatal encephalopathy (NE),1 anecdotal evidence suggests that cooling therapy is increasingly offered to babies with mild NE 2. Here, we report a national survey of cooling practices for babies with mild NE in the UK.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK

Oliveira

Singhvi

Montaldo

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal units contacted, 68 were cooling centres. We received 54 responses (79%) and included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33–34°C core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hours. Babies were ventilated for cooling in two (6%) units and 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in eight (22%) units. MRI and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively. Further research is necessary to ensure optimal neuroprotection in mild encephalopathy.

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“…Our babies were part of a multicentre study, and hence may have had closer monitoring. A recent survey in Australia reported a 20% (21/104) incidence of premature cessation of cooling therapy (due to clinical improvement (n=16) or lack of qualification (n=5) in retrospect) in 104 babies who were cooled despite not meeting the cooling criteria 1. Cooling therapy was also prematurely discontinued in 2% (2/103) of the babies who had originally met the cooling criteria (moderate or severe encephalopathy), due to an apparent clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Although therapeutic hypothermia is the standard therapy for moderate and severe neonatal encephalopathy, cooling therapy is increasingly offered to babies with mild encephalopathy 1. This may be partly due to ‘therapeutic creep’, the expectation that perhaps these babies could also benefit from cooling, the reassurance of the safety profile of cooling in moderate and severe encephalopathy or due to the difficulties in accurately measuring the severity of encephalopathy within 6 hours of birth.…”

Section: Introductionmentioning

confidence: 99%

Residual brain injury after early discontinuation of cooling therapy in mild neonatal encephalopathy

Lally

Montaldo

Oliveira

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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We examined the brain injury and neurodevelopmental outcomes in a prospective cohort of 10 babies with mild encephalopathy who had early cessation of cooling therapy. All babies had MRI and spectroscopy within 2 weeks after birth and neurodevelopmental assessment at 2 years. Cooling was prematurely discontinued at a median age of 9 hours (IQR 5–13) due to rapid clinical improvement. Five (50%) had injury on MRI or spectroscopy, and two (20%) had an abnormal neurodevelopmental outcome at 2 years. Premature cessation of cooling therapy in babies with mild neonatal encephalopathy does not exclude residual brain injury and adverse long-term neurodevelopmental outcomes. This study refers to babies recruited into the MARBLE study (NCT01309711, pre-results stage).

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Eligibility criteria for therapeutic hypothermia: From trials to clinical practice

Cited by 32 publications

References 43 publications

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK

Residual brain injury after early discontinuation of cooling therapy in mild neonatal encephalopathy

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