Hypothermia: Novel approaches for premature infants

Abstract

Hypothermia for hypoxic ischemic encephalopathy has recently permeated clinical practice for term infants. Speculation regarding a neuroprotective benefit of hypothermia for premature infants with HIE has been raised as a need for further research. Hypothermia for other indications including necrotizing enterocolitis with the hope of tissue preservation following injury is less well studied. A summary of evidence for hypothermia and premature infants is presented in this brief report.

Oxygen Sensing Neurons and Neuropeptides Regulate Survival after Anoxia in Developing C. elegans

“…C. elegans is a free living soil nematode that prefers environments with oxygen concentrations ranging between 5 and 12% [4], [7]. Specific oxygen sensing neurons are activated and drive the animal’s response to a preferred envionrment.…”

Thioredoxin 1 and glutaredoxin 2 contribute to maintain the phenotype and integrity of neurons following perinatal asphyxia

“…Several therapeutic approaches to counteract the effects induced by ROS during hypoxia/ischemia and especially reoxygenation have been proposed. However, no neuroprotective agent has been proven safe and effective in the protection of neonates from neurological sequels following an ischemic insult beside hypothermia in some specific cases [21]. Therefore, it is essential to gain more insights into biochemical and cellular mechanisms of neuronal injury induced by PA to identify potential therapeutic targets, compounds and strategies [22].…”

Off-Label Use of Therapeutic Hypothermia for Infants with Hypoxic-Ischemic Encephalopathy

“…A number of large RCTs have shown that reduction of head or whole-body temperature to 3 degrees below normal for 3 days is associated with a 40 to 50 percent reduction in death and long-term disability in term infants with moderate or severe encephalopathy [5], with side effects that are readily manageable and usually of trivial clinical significance. Initiation of therapeutic hypothermia (TH) within 6 hours of birth has rapidly become the standard of care in many NICUs around the developed world [10][11][12].…”

“…Infants with HIE may be quite ill with neurologic dysfunction and multisystem organ failure. Roughly 60 percent of infants with HIE die or carry long-term neurologic impairment [5]; in the worst cases, infants are minimally interactive; require intensive support of breathing, circulation, and vital organ function; and are completely and permanently dependent on caregivers. …”