Hypothermia Reduces Neurological Damage in Asphyxiated Newborn Infants

Abstract

Background: Perinatal asphyxia remains one of the most devastating neurologic processes. There is experimental and clinical evidence that cerebral cooling may suppress the biochemical cascades leading to delayed cerebral damage. Objective: To determine if hypothermia started soon after delivery reduces cerebral damage in term infants. Design/Methods: Retrospective chart analysis with historical controls. Ten asphyxiated newborns treated with hypothermia between October 1998 and October 1999 were compared to 11 asphyxiated newborns admitted from September 1997 to September 1998. Characteristics at birth of infants of the two groups (control and hypothermia) were comparable. After obtaining parental consent, whole-body hypothermia was induced before the 6th hour of life by placing a cold blanket (Polar Air, Augustine Medical Inc., model 600) around the body of the patients. Rectal temperature was maintained between 32 and 34°C for 72 h. Outcome was assessed by neurological evaluation at birth and every 3 months up to the 12th month. Brain MRI was performed in the 2nd month. We had no evidence of severe adverse events related to hypothermia. In the hypothermic group there was a significant (p < 0.05) reduction of major neurologic abnormalities at follow-up and abnormal MRI findings. Conclusions: Hypothermia appears to be safe. Our results on morphological damage evaluated by brain MRI and neurological outcome are encouraging: randomized controlled trials are needed to confirm this experience.

Hypothermic neuroprotection

“…[131][132][133] Although none of these studies were powered or designed to evaluate neurological outcome, there is some suggestion of improved outcomes. 127,134,135 For example, in a controlled study of head cooling among infants with early stage 2 or 3 encephalopathy, mild systemic hypothermia was associated with a trend to reduced cerebral palsy in survivors (odds ratio 0.46 [0.08, 2.56] vs normothermia). 127 A retrospective study of whole body cooling to between 32 and 34°C in 10 infants found a significant reduction of major neurologic abnormalities and abnormal MRI findings at follow-up compared with 11 historical controls.…”

“…127 A retrospective study of whole body cooling to between 32 and 34°C in 10 infants found a significant reduction of major neurologic abnormalities and abnormal MRI findings at follow-up compared with 11 historical controls. 134 A larger randomized pilot study of head cooling with mild hypothermia compared to normothermia found a significant reduction in neuron specific enolase (NSE) levels in cerebral spinal fluid with cooling but only a small increase in normal developmental outcome at 6 months of age in 18 of 23 cooled patients (78.3 %) compared with 19 of 27 (70.4 %) normothermic infants. 135 Finally, a large phase II randomized clinical trial of 65 infants has been reported, in which body cooling to a rectal temperature of 33°C for 48 hours was initiated within 6 hours of birth.…”

Kjøler ned barn etter hjertestans

“…Uttalelsen bygger på forskning gjort på voksne og nyfødte, som viser at hypotermibehandling med temperatur mellom 32-34°C gir få bivirkninger. Ingen spesifikk protokoll anbefales, men de europeiske retningslinjene sier at det muligens kan øke antall overlevende barn uten nevrologiske skader (10)(11)(12). Den amerikanske hjerteforeningens retningslinjer for akutt hjerte-lungeredning av barn og nyfødte uttrykker at hypotermibehandling kan vurderes til barn som fortsatt er komatøse etter resuscitering (13).…”

“…Denne ioneforflytningen fører til at vann følger med inn i cellene. Resultatet er at både cellene og vevet mellom cellene sveller (11,23). Undersøkelser under elektronmikroskop viser at den mest strukturelle skaden i hjernen skjer under denne fasen.…”

Lebensrettende Maßnahmen bei Kindern („paediatric life support“)

“…Eine zentrale Hypothermie (32-34°C) kann von Vorteil sein, während Fieber für das geschä-digte Gehirn nachteilig ist. Eine milde Hypothermie ist ein etabliertes und sicheres Verfahren bei Erwachsenen [361,362] und Neugeborenen [363,364,365,366,367,368]. Obwohl sie das neurologische Outcome von Kindern verbessern kann, wird die therapeutische Hypothermie nach kindlichem Kreislaufstillstand gemäß einer Beobachtungsstudie weder empfohlen noch abgelehnt [369].…”