Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

Abstract

Objective: The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia.Study design: Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5-7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7-10 days of life.Results: A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (w 2 ¼ 15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32±2 in the hypothermic group vs 28±3 in the control group, P<0.01). Conclusions:Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.

Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…Consensus on Science A large body of evidence from 3 large randomized studies (LOE 1 [132][133][134] ) and 2 small randomized trials (LOE 1 135,136 ) demonstrated that induced hypothermia (33.5°to 34.5°C) implemented within 6 hours of birth in term infants at highest risk for brain injury (as defined by specific protocols) and with further treatment in neonatal intensive care units is associated with significantly fewer deaths and less neurodevelopmental disability at 18-month follow-up. The number needed to treat is 9.…”

Therapeutic Hypothermia for Acute Neurological Injuries

“…Reduction in temperature is achieved by running 10°C water through a coil of tubing wrapped around the infant's scalp for 72 hours [91]. Other studies have showed improvement in short-term computed tomographic changes [92], neurodevelopment outcome at 18 months [5], or combined outcome of severe disability and death [93]. As with other surface cooling methods, some devices are adjusted manually or automatically via a feedback mechanism [93].…”

Brain Resuscitation in the Drowning Victim

“…1). There were two systematic reviews [90,91], and five randomized clinical trials (RCT) [92][93][94][95][96] showing increased chance of outcome without disabilities with mild hypothermia therapy. The relative risk (RR) for reduction of death or major neurodevelopmental disability varied between 1.35 and 2.43.…”