Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment

Abstract

Neonatal hypoxic-ischemic encephalopathy (HIE) is an important clinical entity because it is associated with death and long-term disability, including cognitive impairment, cerebral palsy, seizures, and neurosensory deficits. Over the past 40 years, there has been an intensive search to identify therapies to improve the prognosis of neonates with HIE. Hypothermia treatment represents the culmination of laboratory investigations including small and large animal studies, followed by pilot human studies, and, finally, randomized controlled trials to establish efficacy and safety. Clinical trials have demonstrated that hypothermia treatment reduces mortality and improves early childhood outcome among survivors. Hypoxic-ischemic encephalopathy is a multi-system disease process that requires intensive medical support for brain monitoring and monitoring of non–central nervous system organ dysfunction. Treatment must be conducted in a level III or IV neonatal intensive care unit with infrastructure for an integrated approach to care for critically ill neonates. Hypothermia treatment is the first and currently the only therapy to improve outcomes for neonates with HIE and indicates that HIE is modifiable. However, outcomes likely can be improved further. Hypothermia treatment has accelerated investigation of other therapies to combine with hypothermia. It has also stimulated a more intensive approach to brain monitoring, which allows earlier intervention for complications. Finally, HIE and hypothermia treatment negatively influences the psychological state of affected families, and there is growing recognition of the importance of trauma-informed principles to guide medical professionals.

Neuroprotective efficacy of hypothermia and Inter-alpha Inhibitor Proteins after hypoxic ischemic brain injury in neonatal rats

“…The primary objective of the current study was to determine the potential of treatment with hIAIPs and delayed hypothermia to attenuate neuropathological brain injury and possible behavioral deficits resulting from exposure to moderate HI in neonatal rats. Therapeutic hypothermia is the standard care used to treat newborns exposed to HIE [ 52 , [71] , [72] , [73] ]. However, this therapeutic modality is only partially protective, has a narrow therapeutic window, can only be used to treat full-term infants who were exposed to HIE, and cannot be used to treat premature infants exposed to HI-related brain injury [ 52 , [71] , [72] , [73] ].…”

“…Therapeutic hypothermia is the standard care used to treat newborns exposed to HIE [ 52 , [71] , [72] , [73] ]. However, this therapeutic modality is only partially protective, has a narrow therapeutic window, can only be used to treat full-term infants who were exposed to HIE, and cannot be used to treat premature infants exposed to HI-related brain injury [ 52 , [71] , [72] , [73] ]. Consequently, additional therapeutic modalities are needed to further reduce the effects of HI-related brain injury.…”

Hypothermia prevents OGD/R induced injury by activating the PI3K/AKT/mTOR signaling pathway and enhancing autophagy

“…Hypothermia has a signi cant effect on cardiopulmonary resuscitation and neonatal HIE. Hypothermia can reduce seizures of neonatal encephalopathy and focal infarction [11,12] .…”