Mild Controlled Hypothermia in Preterm Neonates With Advanced Necrotizing Enterocolitis

Hall, Nigel; Eaton, Simon; Peters, Mark; Hiorns, Melanie P.; Alexander, Nicholas; Azzopardi, Denis; Pierro, Agostino

doi:10.1542/peds.2008-3211

Cited by 59 publications

(45 citation statements)

References 28 publications

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“…In a nonrandomized feasibility trial, Hall et al administered therapeutic hypothermia to 15 infants with advanced NEC and multiorgan dysfunction. 128 Median gestation at birth of babies in this trial was 27 weeks, with a median admission weight of 1.1 kg. All infants received hypothermia for 48 hours.…”

Section: Therapeutic Hypothermia For Necmentioning

confidence: 88%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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Necrotizing enterocolitis is the most common gastrointestinal emergency in neonates, particularly in those born very preterm. It is a leading cause of morbidity and mortality, especially in extremely low birth weight infants. Despite extensive research, the pathophysiology of necrotizing enterocolitis remains unclear and therapeutic options are limited. Multiple risk factors have been reported, but most are associated with prematurity and its complications. This makes management very challenging in vulnerable preterm infants. In this review, we focus on the risk factors and some of the current research in this area, particularly studies aimed at early detection and potential preventive measures for this potentially lethal condition.

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Section: Therapeutic Hypothermia For Necmentioning

confidence: 88%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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“…On the other hand, induced hypothermia in sick premature infants might have deleterious effects. In this regard, Hall et al [27] showed that induced hypothermia in preterm infants with severe necrotizing enterocolitis significantly impaired all parameters of blood clot dynamics. In addition, Zayek and Eyal [28] showed that hypothermia !…”

Section: Discussionmentioning

confidence: 99%

Does Admission Hypothermia Predispose to Intraventricular Hemorrhage in Very-Low-Birth-Weight Infants?

et al. 2011

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Background: The etiology of intraventricular hemorrhage (IVH) in very-low-birth-weight (VLBW) infants is multifactorial and is associated with low gestational age (GA) and severity of neonatal respiratory disease. The role of admission hypothermia (AHT) in the pathogenesis of IVH in VLBW infants has not yet been elucidated. We searched risk factors for IVH in VLBW infants while focusing on AHT. Patients and Methods: VLBW infants ≤33 weeks’ gestation from three participating medical centers were included. From patients’ medical charts we collected variables known to be associated with IVH, focusing on AHT. AHT was defined as rectal temperature ≤35.5°C at admission to the NICU. Head ultrasound was performed at 2–5 and 6–10 days of age and before discharge. Results: 271 VLBW infants were studied. Univariate analysis showed that AHT at ≤35.5°C was not significantly associated with IVH (all grades; p = 0.16), but associated with IVH grade 3–4 (p = 0.034), while AHT at ≤35°C was significantly associated with IVH (p = 0.036) and with IVH grade 3–4 (p = 0.003). Multivariate logistic regression analysis showed that AHT (at ≤35.5 and at ≤35°C) were not associated with IVH. Only four variables were independently significantly associated with IVH: GA, use of nitric oxide, hypocarbia and base deficit >10. Four variables were strongly associated with severe IVH (grades 3–4): GA, hypotension, base deficit >10 and hyponatremia. Conclusions: In VLBW infants, AHT at ≤35.5 and at ≤35.0°C were not significantly associated with IVH. GA, use of nitric oxide, hypocarbia and base deficit >10 were strongly associated with IVH.

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“…Platelets are activated by either epinephrine or ADP, and the time required for the aperture to close, through adhesion and aggregation of platelets, is reported as the closure time [9] . Other means of quantifying platelet function, not used in the present report, include thromboelastography as employed by Hall et al [10] studying cooling in preterm neonates with advanced necrotizing enterocolitis. Supplementing our measurements with this method might have added useful information to our findings.…”

Section: Discussionmentioning

confidence: 99%

“…Criteria for instituting hypothermia were those suggested by the manufacturer [10] . Also included were an Apgar score ^ 5 at 10 min or a continued need for resuscitation 10 min after birth, or pH !…”

Section: Methodsmentioning

confidence: 99%

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Effect of Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy on Platelet Function

Christensen¹,

Sheffield

Lambert

et al. 2011

Neonatology

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Objective: Platelet dysfunction has been described in adults during hypothermia. We sought to determine whether it also occurs in neonates. Methods: We measured bleeding times and PFA-100 (platelet function analyzer) times in 10 neonates with hypoxic-ischemic encephalopathy during and after head cooling. Results: The 10 neonates were born at 38.2 ± 1.6 weeks’ gestation (mean ± SD), with birth weights of 3,222 ± 746 g, pH 6.79 ± 0.17, base excess –25 ± 8, and 10-min Apgar 4 ± 2. Cooling was instituted 111 min (range: 66–180) after birth and continued 72 h. Bleeding times before cooling averaged 170 s (95% CI: 100–240). These lengthened during hypothermia, averaging 410 s (p = 0.000) and shortened after rewarming (p = 0.000). PFA-100 times were similar: prolongation during cooling and normalization after rewarming. Six neonates had clinical bleeding problems in the first 24 h of cooling, but were managed successfully, and no intracranial hemorrhages were identified. Conclusion: Defective platelet plug formation occurs during therapeutic hypothermia of neonates in a manner similar to that described in adults. Platelet impairment can be severe, but rapidly improves after rewarming.

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Mild Controlled Hypothermia in Preterm Neonates With Advanced Necrotizing Enterocolitis

Abstract: Mild hypothermia for 48 hours in preterm neonates with severe NEC seems both feasible and safe. Additional investigation of the efficacy of this therapeutic intervention in this population is warranted.

Cited by 59 publications

References 28 publications

Necrotizing enterocolitis: current perspectives

Necrotizing enterocolitis: current perspectives

Does Admission Hypothermia Predispose to Intraventricular Hemorrhage in Very-Low-Birth-Weight Infants?

Effect of Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy on Platelet Function

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