Predicting death despite therapeutic hypothermia in infants with hypoxic-ischaemic encephalopathy

Abstract

Of the selected precooling variables, only the 10 min Apgar score is independently associated with death despite therapeutic cooling in infants with HIE. Infants who remain asystolic at 10 min and beyond are unlikely to survive despite cooling, and the rare survivor is likely to have severe disability.

Part 7: Neonatal Resuscitation

“…250,251,253 For the critical outcome of death or moderate/severe neurodevelopmental impairment at 22 months of age or older, 6 studies (very-low-quality evidence, downgraded for risk of bias, inconsistency, indirectness, and imprecision) showed this outcome in 106 of 129 infants (85%) with a gestational age of 36 weeks or greater and an Apgar score of 0 at 10 minutes of life. [248][249][250][251][252][253] Results from 3 of these studies performed after 2009 (very-low-quality evidence, downgraded for risk of bias, inconsistency, indirectness, and imprecision) that included nested observational series in randomized clinical trials of therapeutic hypothermia and series of infants who received therapeutic hypothermia showed that this adverse outcome occurred in 68 of 90 infants (76%) with an Apgar score of 0 at 10 minutes. Among the 44 survivors of these studies, 22 (50%) survived without major/ moderate disabilities.…”

“…[248][249][250][251][252][253] Results from 3 of these studies performed after 2009 that included nested observational series of cases from 3 randomized clinical trials of therapeutic hypothermia and a series of infants who received therapeutic hypothermia outside a randomized trial (lowquality evidence, downgraded for risk of bias) found that 46 of 90 infants (51%) with an Apgar score of 0 at 10 minutes died before 22 months of age. 250,251,253 For the critical outcome of death or moderate/severe neurodevelopmental impairment at 22 months of age or older, 6 studies (very-low-quality evidence, downgraded for risk of bias, inconsistency, indirectness, and imprecision) showed this outcome in 106 of 129 infants (85%) with a gestational age of 36 weeks or greater and an Apgar score of 0 at 10 minutes of life.…”

“…[248][249][250][251][252][253] Results from 3 of these studies performed after 2009 that included nested observational series of cases from 3 randomized clinical trials of therapeutic hypothermia and a series of infants who received therapeutic hypothermia outside a randomized trial (lowquality evidence, downgraded for risk of bias) found that 46 of 90 infants (51%) with an Apgar score of 0 at 10 minutes died before 22 months of age. 250,251,253 For the critical outcome of death or moderate/severe neurodevelopmental impairment at 22 months of age or older, 6 studies (very-low-quality evidence, downgraded for risk of bias, inconsistency, indirectness, and imprecision) showed this outcome in 106 of 129 infants (85%) with a gestational age of 36 weeks or greater and an Apgar score of 0 at 10 minutes of life. [248][249][250][251][252][253] Results from 3 of these studies performed after 2009 (very-low-quality evidence, downgraded for risk of bias, inconsistency, indirectness, and imprecision) that included nested observational series in randomized clinical trials of therapeutic hypothermia and series of infants who received therapeutic hypothermia showed that this adverse outcome occurred in 68 of 90 infants (76%) with an Apgar score of 0 at 10 minutes.…”

“…Among the 44 survivors of these studies, 22 (50%) survived without major/ moderate disabilities. Among the 56 cooled infants in these studies, 15 (27%) survived without major/moderate disabilities 250,251,253 (very-low-quality evidence, downgraded for risk of bias).…”

Part 13: Neonatal Resuscitation

“…We suggest that, in infants with an Apgar score of 0 after 10 minutes of resuscitation, if the heart rate remains undetectable, it may be reasonable to stop assisted ventilation; however, the decision to continue or discontinue resuscitative efforts must be individualized. Variables to be considered may include whether the resuscitation was considered optimal; availability of advanced neonatal care, such as therapeutic hypothermia; specific circumstances before delivery (eg, known timing oftheinsult);andwishesexpressedbythe family [201][202][203][204][205][206] (Class IIb, LOE C-LD).…”