Innate Hypothermia after Hypoxic Ischaemic Delivery

Jayasinghe, Dulip

doi:10.1159/000369119

Cited by 19 publications

(10 citation statements)

References 36 publications

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“… 9 , 10 Most, if not all available data suggest, however, that whenever the baby is separated from the mother, whether for asphyxia, resuscitation or RDS, particular attention needs to be given to its thermoregulation. A causality cannot be deferred as hypothermia may be secondary to asphyxia dysregulation 23 and RDS a compensation for increased oxygen requirements to fight hypothermia. 24 …”

Section: Discussionmentioning

confidence: 99%

Hypothermia in Preterm Newborns: Impact on Survival

Demtse

Pfister

Nigussie

et al. 2020

Global Pediatric Health

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Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates (<37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were the main factors associated with hypothermia. The very high prevalence and association with mortality warrants quality improvement interventions.

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Section: Discussionmentioning

confidence: 99%

Hypothermia in Preterm Newborns: Impact on Survival

Demtse

Pfister

Nigussie

et al. 2020

Global Pediatric Health

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“…limb flexion to reduce exposed surface area and crying to attract maternal attention) and autonomic [e.g. vasoconstriction and non‐shivering thermogenesis within brown adipose tissue (BAT)] (Jayasinghe, ). Newborn infants at term age have a high proportion of BAT, which enables them to endure cold stress after birth (Aherne & Hull, ).…”

Section: Discussionmentioning

confidence: 99%

Core temperature after birth in babies with neonatal encephalopathy in a sub‐Saharan African hospital setting

Enweronu‐Laryea

Martinello

Rose

et al. 2019

The Journal of Physiology

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Key points Therapeutic hypothermia (HT) to 33.0–34.0°C for 72 h provides optimal therapy for infants with neonatal encephalopathy (NE) in high‐resource settings. HT is not universally implemented in low‐ and middle‐income countries as a result of both limited resources and evidence. Facilitated passive cooling, comprising infants being allowed to passively lower their body temperature in the days after birth, is an emerging practice in some West African neonatal units. In this observational study, we demonstrate that infants undergoing facilitated passive cooling in a neonatal unit in Accra, Ghana, achieve temperatures within the HT target range ∼20% of the 72 h. Depth of HT fluctuates and can be excessive, as well as not maintained, especially after 24 h. Sustained and deeper passive cooling was evident for severe NE and for those that died. It is important to prevent excessive cooling, to understand that severe NE babies cool more and to be aware of facilitated passive cooling with respect to the design of clinical trials in low‐ and mid‐resource settings. Abstract Neonatal encephalopathy (NE) is a significant worldwide problem with the greatest burden in sub‐Saharan Africa. Therapeutic hypothermia (HT), comprising the standard of care for infants with moderate‐to‐severe NE in settings with sophisticated intensive care, is not available to infants in many sub‐Saharan African countries, including Ghana. We prospectively assessed the temperature response in relation to outcome in the 80 h after birth in a cohort of babies with NE undergoing ‘facilitated passive cooling’ at Korle Bu Teaching Hospital, Accra, Ghana. We hypothesized that NE infants demonstrate passive cooling. Thirteen infants (69% male) ≥36 weeks with moderate‐to‐severe NE were enrolled. Ambient mean ± SD temperature was 28.3 ± 0.7°C. Infant core temperature was 34.2 ± 1.2°C over the first 24 h and 35.0 ± 1.0°C over 80 h. Nadir mean temperature occurred at 15 h. Temperatures were within target range for HT with respect to 18 ± 14% of measurements within the first 72 h. Axillary temperature was 0.5 ± 0.2°C below core. Three infants died before discharge. Core temperature over 80 h for surviving infants was 35.3 ± 0.9°C and 33.96 ± 0.7°C for those that died (P = 0.043). Temperature profile negatively correlated with Thompson NE score on day 4 (r2 = 0.66): infants with a Thompson score of 0–6 had higher temperatures than those with a score of 7–15 (P = 0.021) and a score of 16+/deceased (P = 0.007). More severe NE was associated with lower core temperatures. Passive cooling is a physiological response after hypoxia–ischaemia; however, the potential neuroprotective effect of facilitated passive cooling is unknown. An awareness of facilitated passive cooling in babies with NE is important for the design of clinical trials of neuroprotection in low and mid resource settings.

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“…). The correlation between degree of spontaneous hypothermia and severity of injury and outcome have not yet been described, although it has previously proposed as a potential biomarker for degree of injury in this population (Jayasinghe, ).…”

Section: Introductionmentioning

confidence: 99%

“…More recently, the degree of spontaneous hypothermia has been linked to the severity of injury, suggesting disruption of the thermoregulatory circuitry (Enweronu-Laryea et al 2019). The correlation between degree of spontaneous hypothermia and severity of injury and outcome have not yet been described, although it has previously proposed as a potential biomarker for degree of injury in this population (Jayasinghe, 2015).…”

Section: Introductionmentioning

confidence: 99%

Active cooling temperature required to achieve therapeutic hypothermia correlates with short‐term outcome in neonatal hypoxic‐ischaemic encephalopathy

Mietzsch

Radhakrishnan

Boyle

et al. 2020

The Journal of Physiology

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Key points Hypoxic‐ischaemic encephalopathy (HIE) affects 2–4/1000 live term births. Treatment with therapeutic hypothermia (TH) improves the long‐term neurodevelopmental outcome of neonates with moderate to severe HIE. However, early prediction of outcome still remains challenging, and no reliable and easily obtainable biomarker has been identified to date. Neonates with HIE display impaired thermoregulation, resulting in spontaneous hypothermia. The degree of cooling required to achieve TH may therefore act as a biomarker of injury severity. The present study demonstrates a correlation between servo‐controlled mattress temperature during TH and short‐term outcome. Neonates with an unfavourable outcome require less cooling to maintain a core temperature between 33 and 34°C during TH compared to neonates with a favourable outcome. The degree of impaired temperature regulation was strongly associated with a high magnetic resonance imaging injury score and death. Cooling device output temperature is a potential and easily obtainable early physiological biomarker of outcome in infants with HIE undergoing TH. Abstract Neonatal hypoxic‐ischaemic encephalopathy (HIE) is a leading cause of death and disability in children. Therapeutic hypothermia (TH) at 33.5°C for 72 h is the only therapy to date shown to improve outcome in moderate to severe HIE; however, assessment of severity and prediction of outcome remains challenging. Infants with HIE display significant physiological perturbations, including spontaneous hypothermia. We hypothesized that neonates with more severe brain injury on magnetic resonance imaging (MRI) would exhibit a greater degree of spontaneous hypothermia, and thus require less active cooling to attain TH. Twenty‐eight neonates with moderate or severe HIE treated with TH were included in the present study. MRI images obtained on day of life 4–7 were scored according to standardized injury criteria. Unfavourable outcome was defined as death or significant grey matter injury on MRI according to a previously validated scoring system. A significantly higher cooling device output temperature was seen in infants with an unfavourable outcome. All neonates who required the mattress to provide a temperature ≥32°C to maintain their core body temperature at 33.5°C had a high likelihood of unfavourable outcome (likelihood ratio = 14.4). By contrast, infants who never required a device output temperature ≥32°C had a low likelihood of an unfavourable outcome (likelihood ratio = 0.07, P < 0.001). Infants with significant grey matter injury on MRI require less active cooling to maintain target temperature during TH. The cooling device output temperature has the potential to be an easily accessible physiological biomarker and predictor of injury and mortality in neonates with moderate or severe HIE.

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Innate Hypothermia after Hypoxic Ischaemic Delivery

Cited by 19 publications

References 36 publications

Hypothermia in Preterm Newborns: Impact on Survival

Hypothermia in Preterm Newborns: Impact on Survival

Core temperature after birth in babies with neonatal encephalopathy in a sub‐Saharan African hospital setting

Active cooling temperature required to achieve therapeutic hypothermia correlates with short‐term outcome in neonatal hypoxic‐ischaemic encephalopathy

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