Hypothermia for the treatment of infants with hypoxic–ischemic encephalopathy

Pfister, Robert H.; Soll, Roger F.

doi:10.1038/jp.2010.91

Cited by 49 publications

(28 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recent randomized controlled trials have shown that therapeutic hypothermia initiated within 6 h of birth reduces death and disability in these infants. 24 Induced under controlled clinical conditions, therapeutic hypothermia has been discussed as being beneficial and outweighing the adverse effects in term newborns with hypoxic ischemic encephalopathy 25 and during or after cardiac surgery. 26 …”

Section: Neonatal Thermoregulationmentioning

confidence: 99%

Thermal protection of the newborn in resource-limited environments

2012

View full text Add to dashboard Cite

Appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality. Yet, current global birth practices tend to not adequately address this challenge. Here, we discuss the pathophysiology of hypothermia in the newborn, its prevention and therapeutic options with particular attention to resource-limited environments. Newborns are equipped with sophisticated mechanisms of body temperature regulation. Neonatal thermoregulation is a critical function for newborn survival, regulated in the hypothalamus and mediated by endocrine pathways. Hypothermia activates cellular metabolism through shivering and nonshivering thermogenesis. In newborns, optimal temperature ranges are narrow and thermoregulatory mechanisms easily overwhelmed, particularly in premature and low-birth weight infants. Hyperthermia most commonly is associated with dehydration and potentially sepsis. The lack of thermal protection promptly leads to hypothermia, which is associated with detrimental metabolic and other pathophysiological processes. Simple thermal protection strategies are feasible at community and institutional levels in resource-limited environments. Appropriate interventions include skin-to-skin care, breastfeeding and protective clothing or devices. Due to poor provider training and limited awareness of the problem, appropriate thermal care of the newborn is often neglected in many settings. Education and appropriate devices might foster improved hypothermia management through mothers, birth attendants and health care workers. Integration of relatively simple thermal protection interventions into existing mother and child health programs can effectively prevent newborn hypothermia even in resource-limited environments.

show abstract

Section: Neonatal Thermoregulationmentioning

confidence: 99%

Thermal protection of the newborn in resource-limited environments

2012

View full text Add to dashboard Cite

show abstract

“…Of importance, neonates who are hypothermia candidates must be cooled within 6 hours of the initial neurological insult. 4 Neonates with severe HIE are usually recognized as stuporous and flaccid, with poor or no respiratory effort early in their course. Because of these signs, neonates with severe HIE are identified early and considered hypothermia candidates without delay.…”

Section: Freeze Warning: Early Recognition Of Potential Hypothermia Cmentioning

confidence: 99%

“…Moreover, expert opinion indicates that cooling should be initiated as early as feasible, preferably within 2 hours. 4 Passive cooling involves withholding any external heat sources and monitoring the neonate's temperature frequently. Maintaining the temperature within a target range is difficult, and infants often arrive to the tertiary NICU with temperatures outside of the target range.…”

Section: Passive Hypothermiamentioning

confidence: 99%

“…Moreover, expert opinion indicates that cooling should be initiated as early as feasible, preferably within 2 hours of birth. 4 This critical window is easily achieved when infants are born in a tertiary care center with all the necessary cooling equipment and personnel. However, infants born at hospitals not able to provide this level of care require transport to a tertiary care center that offers hypothermia therapy.…”

mentioning

confidence: 99%

See 1 more Smart Citation

While Waiting

Sussman

Weiss

2013

Advances in Neonatal Care

View full text Add to dashboard Cite

Hypoxic-ischemic encephalopathy (HIE) occurring during the perinatal period is one of the primary causes of severe, long-term neurological deficits in children. Initial systemic supportive therapy remains a critical aspect of HIE management. In addition to support therapy, the widespread use of hypothermia has demonstrated a reduction in death and neurodevelopmental disability in infants with moderate to severe HIE. Neonates with HIE born outside of tertiary care centers must be rapidly identified as hypothermia candidates and have emergent transport arranged. While waiting for the transport team to arrive, these neonates often require intensive stabilization, including meticulous temperature management. This article examines the need for HIE outreach teaching programs, assists in the identification of a neonate for hypothermia therapy, and supplies evidence-based recommendations for the initial stabilization and care of neonates delivered at nontertiary care facilities. The guidelines and materials supplied represent the outreach model used by our regional hypothermia center and disseminated to the surrounding referral hospitals.

show abstract

“…With improved understanding of the pathophysiology of HIE, we now understand that lowering body temperature attenuates the cellular response to hypoxic-ischemic injury, interrupting the cascade of events that appears to contribute to poor outcomes [9]. A number of large RCTs have shown that reduction of head or whole-body temperature to 3 degrees below normal for 3 days is associated with a 40 to 50 percent reduction in death and long-term disability in term infants with moderate or severe encephalopathy [5], with side effects that are readily manageable and usually of trivial clinical significance.…”

Section: Introductionmentioning

confidence: 99%