Targeted Temperature Management in Pediatric Neurocritical Care

Benedetti, Giulia M.; Silverstein, Faye S.

doi:10.1016/j.pediatrneurol.2018.07.004

Cited by 15 publications

(8 citation statements)

References 113 publications

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“…Hypothermia is used as a therapeutic intervention to reduce ischemic injury following neonatal hypoxic-ischemic encephalopathy, post cardiac arrest encephalopathy, and traumatic brain injury [2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…The condition is permanent but can either be static or progressive [1]. Hypothermia is defined as a temperature less than 35 • C. Acute cytopenia following hypothermia from environmental exposure or induced as medical therapy has been reported [2][3][4]. This is the first report of chronic pancytopenia, indicating a reduction in all three blood cell lines, due to centrally mediated hypothermia in two patients with SNI.…”

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confidence: 99%

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Chronic Pancytopenia Due to Centrally Mediated Hypothermia in Two Children with Severe Neurological Impairment

Fratantoni

Hauer

2020

Children

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We report on recurrent pancytopenia over five years in two children with severe impairment of the central nervous system. Assessment by hematology did not identify an etiology, including bone marrow biopsy in one. Both patients had sustained normalized blood cell counts following interventions to maintain or return to a temperature above 33 °C. Acute cytopenias following medically induced and environmental hypothermia have been reported. Recurrent pancytopenia due to centrally mediated hypothermia in patients with severe neurological impairment is often not recognized, putting such children at risk for unnecessary testing and transfusions. We provide a practical approach to management that is feasible for caregivers in the home setting with suggestions for monitoring.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Chronic Pancytopenia Due to Centrally Mediated Hypothermia in Two Children with Severe Neurological Impairment

Fratantoni

Hauer

2020

Children

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“…Methodological heterogeneity makes synthesizing data problematic and difficult to interpret. [33,34] Future studies should use standardized outcomes (eg: Utstein template) to help improve the amount of comparative data available. [15] In the THAPCA IHCA trial, of the nearly 2800 children who were screened for enrolment, 73% were excluded.…”

Section: Discussionmentioning

confidence: 99%

Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis

et al. 2019

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“…Given the increased tolerance of children and by analogy to the evidence-based benefit in neonates [ 49 , 50 , 51 , 52 ], it would be tempting to use hypothermia as a therapeutic strategy after hypoxic–ischemic events or even traumatic impacts in pediatric critical care. However, the available evidence, both in out-of-hospital or in-hospital cardiac arrest [ 91 , 92 ] and in traumatic brain injury [ 93 , 94 ], suggests that there is no benefit compared with a temperature management targeted at maintaining normothermia and preventing fever [ 95 , 96 ], which often requires some degree of cooling in children anyway. The disappointing evidence is consistent with the above-mentioned findings in adults [ 54 , 55 ] and may, in children, be additionally due to the heterogeneity of critical care patients and the invasiveness of intensive care procedures counteracting the modest benefit of slightly reduced body temperatures.…”

Section: Pediatric Hypothermiamentioning

confidence: 99%

Pediatric Hypothermia: An Ambiguous Issue

Singer

2021

IJERPH

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Hypothermia in pediatrics is mainly about small body size. The key thermal factor here is the large surface-to-volume ratio. Although small mammals, including human infants and children, are adapted to higher heat losses through their elevated metabolic rate and thermogenic capacity, they are still at risk of hypothermia because of a small regulatory range and an impending metabolic exhaustion. However, some small mammalian species (hibernators) use reduced metabolic rates and lowered body temperatures as adaptations to impaired energy supply. Similar to nature, hypothermia has contradictory effects in clinical pediatrics as well: In neonates, it is a serious risk factor affecting respiratory adaptation in term and developmental outcome in preterm infants. On the other hand, it is an important self-protective response to neonatal hypoxia and an evidence-based treatment option for asphyxiated babies. In children, hypothermia first enabled the surgical repair of congenital heart defects and promotes favorable outcome after ice water drowning. Yet, it is also a major threat in various prehospital and clinical settings and has no proven therapeutic benefit in pediatric critical care. All in all, pediatric hypothermia is an ambiguous issue whose harmful or beneficial effects strongly depend on the particular circumstances.

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Targeted Temperature Management in Pediatric Neurocritical Care

Cited by 15 publications

References 113 publications

Chronic Pancytopenia Due to Centrally Mediated Hypothermia in Two Children with Severe Neurological Impairment

Chronic Pancytopenia Due to Centrally Mediated Hypothermia in Two Children with Severe Neurological Impairment

Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis

Pediatric Hypothermia: An Ambiguous Issue

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