Whole Body Hypothermia for
Neonatal Hypoxic Ischemic Encephalopathy
Hypoxic-ischemic encephalopathy (HIE) may
cause neurodevelopmental deficits and
death in infants. The rate of HIE in the 
36 weeks) with HIE
(defined as either severe acidosis or perinatal
complications and resuscitation at birth). Within 6 hours of birth,
infants received either usual care (overhead radiant warmers) or
whole-body cooling (with water blankets regulated to achieve an
esophageal temperature of 33.5oC) for 72 hours.
Compared with infants who received usual
care, those who underwent cooling were significantly less likely to
have died or have moderate or severe disability (collective rates of
IQ, motor function, blindness, and hearing impairment) at age 18 to
22 months (44% vs. 62%). Adjustment for severity of encephalopathy
at randomization did not change the results. Individual rates of
cerebral palsy, blindness, and hearing impairment among survivors did
not differ significantly between the two groups. The incidence of
serious adverse events (e.g., hypotension, cardiac arrhythmia, or oliguria) was similar in the two groups.
Comment: These encouraging results suggest that whole-body
cooling may be an effective therapy for hypoxic-ischemic
encephalopathy in term and asphyxiated infants. In a previous
randomized study of brain cooling for HIE, no differences in rates
of death and disability were found. As noted by an editorialist, one
explanation for the different results is that systemic whole-body
hypothermia resulted in more rapid cooling than brain cooling alone.
Unfortunately, many neonates with HIE are born in community
hospitals, where quickly instituting such an intensive intervention
as whole-body cooling may be difficult to accomplish. In addition,
these results do not pertain to premature infants.
—
Published in Journal Watch Pediatrics and Adolescent Medicine
December 30, 2005
Source
Shankaran S et al. Whole-body hypothermia for neonates with hypoxic-ischemic
encephalopathy.
Papile L-A. Systemic
hypothermia -- A "cool" therapy for neonatal hypoxic-ischemic
encephalopathy.