Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy

Abstract

In neonates with postintrapartum asphyxial hypoxic-ischemic encephalopathy, hypothermia is effective in reducing death and moderate to severe neurodevelopmental disability either in combination or separately and is a safe intervention.

Persistent pulmonary hypertension and short-term neurological outcomes in infants with moderate to severe hypoxic ischemic encephalopathy

“…These differing results may be contributed to the smaller sample size and the more select group. Our results are in keeping with the rate of seizure burden in prior studies: Shah's systematic review of 6 studies including 275 infants also reported clinical seizures in 50% of TH-treated HIE infants [5]. Electrographic seizures occurred in 28% in our cohort, compared to 29% in Wietstock's series of 212 HIE infants [15], and our 46% incidence of abnormal EEG pattern was comparable with Shah's report of 49% [16].…”

“…The rate of clinical PPHN in infants with moderate to severe HIE who underwent TH in our study is with 19.7% comparable to the incidence of 15–25% reported in previous studies [5,7,17, 5,7,17]. Those with clinical PPHN in our cohort showed signs of being more severely ill, compared to the non-PPHN group, in form of needing more ventilatory and inotropic support, and having worse end organ laboratory values (Table 1).…”

“…Overall, the clinical PPHN group was sicker with lower 10-minute APGAR score (4 [2-6] vs 6 [4][5][6][7], p = 0.03), higher maximum lactate (13.9 vs 11.5 mmol/l, p = 0.006), more frequent inotrope use (94.4 vs 32.7%, p < 0.001), hypoglycemia (44.4 vs 27.3%, p = 0.014), early onset sepsis (5.6 vs 0.45%, p = 0.005), and more early exit from TH (13 vs 4.5%, p = 0.022). There was higher ventilation need in clinical PPHN, compared to non-PPHN infants (Table 1): All infants in the PPHN group required mechanical ventilation, with about half requiring High Frequency Oscillatory Ventilation (HFOV), compared to the non-PPHN group with 61.4% on Conventional Mechanical Ventilation and only 2.3% on HFOV (Table 1, p < 0.001)).…”

Neonatal Thrombocytopenia after Perinatal Asphyxia Treated with Hypothermia: A Retrospective Case Control Study

“…Meta-analysis of these eight trials showed a relative risk of thrombocytopenia in the hypothermia group of 1.21 (95% CI 1.05–1.40) compared to the control group [14]. This was in accordance with another systematic review from Shah et al in 2007 (RR 1.51, 95% CI 1.09–2.10) [12]. In this review thrombocytopenia was defined as a platelet count below 100 × 10 9 /L and three randomized studies were analyzed [7, 8, 17].…”

Therapeutic hypothermia in asphyxiated newborns: selective head cooling vs. whole body cooling — comparison of short term outcomes

“…The aforementioned research conducted by Atici did not notice the differences in the risk of thrombocytopenia either [24]. Moreover, other researchers reported no differences in organ failure parameters including haematological, coagulogical and cardiovascular ones [31].…”