Temperature dysregulation during therapeutic hypothermia predicts long-term outcome in neonates with HIE

Abstract

Few reliable or easily obtainable biomarkers to predict long-term outcome in infants with hypoxic-ischemic encephalopathy (HIE) have been identified. We previously showed that mattress temperature (MT), as proxy for disturbed temperature regulation during therapeutic hypothermia (TH), predicts injury on early MRI and holds promise as physiologic biomarker. To determine whether MT in neonates treated with TH for moderate-severe HIE is associated with long-term outcome at 18–22 months, we performed a secondary analysis of the Optimizing Cooling trial using MT data from 167 infants treated at a core temperature of 33.5°C. Median MTs from four time-epochs (0–6 h, 6–24 h, 24–48 h, and 48–72 h of TH) were used to predict death or moderate-severe neurodevelopmental impairment (NDI), using epoch-specific derived and validated MT cutoffs. Median MT of infants who died or survived with NDI was consistently 1.5–3.0°C higher throughout TH. Infants requiring a median MT above the derived cut-offs had a significantly increased odds of death or NDI, most notably at 0–6 h (aOR 17.0, 95%CI 4.3–67.4). By contrast, infants who remained below cut-offs across all epochs had 100% NDI-free survival. MTs in neonates with moderate-severe HIE during TH are highly predictive of long-term outcome and can be used as physiologic biomarker.

Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial

“…Dr Harvey Sarnat himself recently proposed re-evaluating the SE, advocating for studies weighing the predictive value of each component of the SE with the goal of modifying the scoring system and/or identifying specific risks based on severity and timing of component abnormality 32. Using the rSE may enhance the prognostic ability, particularly when combined with other metrics such as blood glucose, cooling mattress temperature, MRI, MRS (magnetic resonance spectroscopy) and EEG (electroencephalogram) 33–36. Furthermore, it is plausible that the evolution of the SE and its individual components may assist in the characterisation of an individualised injury profile and facilitate tailored therapies and resource allocation 37 38.…”