Treatment of Term Infants With Head Cooling and Mild Systemic Hypothermia (35.0°C and 34.5°C) After Perinatal Asphyxia

Battin, Malcolm; Penrice, J; Gunn, Tania R.; Gunn, Alistair J.

doi:10.1542/peds.111.2.244

Cited by 185 publications

(109 citation statements)

References 32 publications

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“…Pragmatically, partially selective cerebral cooling can be obtained using a cooling cap applied to the scalp, while the body is warmed by some method such as an overhead heater to limit the degree of systemic hypothermia. 126,128,149 A mild (ϳ34 to 35°C) degree of systemic hypothermia is still desirable during head cooling; firstly to reduce the steepness of the intracerebral gradient which develops during true selective head cooling, 150 avoiding excessively cold cap temperatures which might cause scalp injury or exacerbate local scalp edema, 128 and to provide at least some cooling of deep cerebral structures such as the brain stem. This approach has recently been demonstrated in the piglet to be associated with a substantial (median, 5.3°C), sustained decrease in deep intracerebral temperature at the level of the basal ganglia compared with the rectal temperature.…”

Section: Is Head or Whole Body Cooling Better?mentioning

confidence: 99%

“…157,158 There are no systematic data from large animals. The clinical studies of therapeutic hypothermia have empirically chosen to rewarm infants at no more than 0.5°C per h, 128,130,132 however, it remains possible that rewarming still more slowly might be beneficial. Further, there is some evidence that worsening of intracranial pressure during rewarming in adult patients with head injury may be able to be avoided by an extremely slow rewarming schedule, although it is still not known whether this improves long-term outcomes.…”

Section: How Long Should Cooling Be Continued?mentioning

confidence: 99%

“…Consequently, hypothermia to less than approximately 35.5°C is associated with mild but sustained sinus bradycardia, however this has not required treatment. 128,130,138,141 This linear relation between heart rate and core temperature likely partly reflects the increased metabolic need with increasing temperature. Electrocardiograms done in infants with sustained heart rates of Ͻ90 bpm confirmed that some show markedly prolonged QT duration above the 98 th percentile corrected for age and heart rate, without arrhythmia.…”

Section: Just How Safe Is Cooling In Infants With Hie?mentioning

confidence: 99%

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Hypothermic neuroprotection

Gunn

Thoresen

2006

NeuroRX

212

128

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Summary:The possibility that hypothermia during or after resuscitation from asphyxia at birth, or cardiac arrest in adults, might reduce evolving damage has tantalized clinicians for a very long time. It is now known that severe hypoxia-ischemia may not necessarily cause immediate cell death, but can precipitate a complex biochemical cascade leading to the delayed neuronal loss. Clinically and experimentally, the key phases of injury include a latent phase after reperfusion, with initial recovery of cerebral energy metabolism but EEG suppression, followed by a secondary phase characterized by accumulation of cytotoxins, seizures, cytotoxic edema, and failure of cerebral oxidative metabolism starting 6 to 15 h post insult. Although many of the secondary processes can be injurious, they appear to be primarily epiphenomena of the 'execution' phase of cell death. Studies designed around this conceptual framework have shown that moderate cerebral hypothermia initiated as early as possible before the onset of secondary deterioration, and continued for a sufficient duration in relation to the severity of the cerebral injury, has been associated with potent, long-lasting neuroprotection in both adult and perinatal species. Two large controlled trials, one of head cooling with mild hypothermia, and one of moderate whole body cooling have demonstrated that post resuscitation cooling is generally safe in intensive care, and reduces death or disability at 18 months of age after neonatal encephalopathy. These studies, however, show that only a subset of babies seemed to benefit. The challenge for the future is to find ways of improving the effectiveness of treatment.

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Section: Is Head or Whole Body Cooling Better?mentioning

confidence: 99%

Section: How Long Should Cooling Be Continued?mentioning

confidence: 99%

Section: Just How Safe Is Cooling In Infants With Hie?mentioning

confidence: 99%

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Hypothermic neuroprotection

Gunn

Thoresen

2006

NeuroRX

212

128

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“…Eine zentrale Hypothermie (32-34°C) kann von Vorteil sein, während Fieber für das geschä-digte Gehirn nachteilig ist. Eine milde Hypothermie ist ein etabliertes und sicheres Verfahren bei Erwachsenen [361,362] und Neugeborenen [363,364,365,366,367,368]. Obwohl sie das neurologische Outcome von Kindern verbessern kann, wird die therapeutische Hypothermie nach kindlichem Kreislaufstillstand gemäß einer Beobachtungsstudie weder empfohlen noch abgelehnt [369].…”

Section: Kontrolle Und Management Der Körpertemperaturunclassified

Lebensrettende Maßnahmen bei Kindern („paediatric life support“)

Biarent

Bingham

Eich

et al. 2010

Notfall Rettungsmed

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“…Recently, this has stimulated attempts to decrease brain metabolism by using moderate systemic hypothermia or localized brain hypothermia. However, the window of opportunity for this therapy is open for only a short time (66).…”

Section: Respiratory Supportmentioning

confidence: 99%

The Evolution of Neonatology

Philip

2005

Pediatr Res

539

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In 1960, the terms "neonatology" and "neonatologist" were introduced. Thereafter, an increasing number of pediatricians devoted themselves to full-time neonatology. In 1975, the first examination of the Sub-Board of Neonatal-Perinatal Medicine of the American Board of Pediatrics and the first meeting of the Perinatal Section of the American Academy of Pediatrics were held. One of the most important factors that improved the care of the neonate was the miniaturization of blood samples needed to determine blood gases, serum electrolytes, glucose, calcium, bilirubin, and other biochemical measurements. Another factor was the ability to provide nutrition intravenously, and the third was the maintenance of normal body temperature. The management of respiratory distress syndrome improved with i.v. glucose and correction of metabolic acidosis, followed by assisted ventilation, continuous positive airway pressure, antenatal corticosteroid administration, and the introduction of exogenous surfactant. Pharmacologic manipulation of the ductus arteriosus, support of blood pressure, echocardiography, and changes in the management of persistent pulmonary hypertension, including the use of nitric oxide and extracorporeal membrane oxygenation, all have influenced the cardiopulmonary management of the neonate. Regionalization of neonatal care; changes in parent-infant interaction; and technological changes such as phototherapy, oxygen saturation monitors, and brain imaging techniques are among the important advances reviewed in this report. Most remarkable, a 1-kg infant who was born in 1960 had a mortality risk of 95% but had a 95% probability of survival by 2000. However, errors in neonatology are acknowledged, and potential directions for the future are explored. Abbreviations AAP, American Academy of Pediatrics BPD, bronchopulmonary dysplasia CPAP, continuous positive airway pressure ECMO, extracorporeal membrane oxygenation ELBW, extremely low birth weight HMD, hyaline membrane disease iNO, inhaled nitric oxide IUGR, intrauterine growth restriction IVH, intraventricular hemorrhage L/S, ratio of lecithin, phosphatidyl choline, to sphingomyelin NICU, neonatal intensive care unit PDA, patent ductus arteriosus PEEP, positive end expiratory pressure PPHN, persistent pulmonary hypertension of the newborn PVH, periventricular hemorrhage RDS, respiratory distress syndrome ROP, retinopathy of prematurity SIDS, sudden infant death syndrome VLBW, very low birth weight VON, Vermont-Oxford Network "There is need for specialization in neonatal medicine. This applies to doctors and nurses as well as teaching and construction of hospitals. The specialist in neonatal diseases and the nurse intensively trained and expert in the management of delicate newborns will be commonplace ere long." J.W. Ballantyne, 1923 (1) "In previous times the problems of the newborn child have been the province of the obstetrician, a field in which he has taken comparatively little interest and to which he has contributed little. As pediatricians we have but s...

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Treatment of Term Infants With Head Cooling and Mild Systemic Hypothermia (35.0°C and 34.5°C) After Perinatal Asphyxia

Abstract: This study suggests that selective head cooling combined with mild systemic hypothermia of 34.4 degrees C or 35.0 degrees C is a stable, well-tolerated method of reducing cerebral temperature in term newborn infants after perinatal asphyxia.

Cited by 185 publications

References 32 publications

Hypothermic neuroprotection

Hypothermic neuroprotection

Lebensrettende Maßnahmen bei Kindern („paediatric life support“)

The Evolution of Neonatology

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