Moderate hypothermia in neonatal encephalopathy: Efficacy outcomes

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

“…It remains a detrimental factor in roughly 1 of every 500 live term births in developed nations, leading to long-term neurological and developmental disabilities (20). Recent clinical trials have demonstrated that the incidence of death and disability from hypoxia-ischemia in newborns can be significantly reduced by initiating treatment strategies, hypothermia, for example, after birth and within a 6-h therapeutic window (9,11,14,32). Due to the brevity of the therapeutic window, early detection of injury and early determination of those infants who are likely candidates for treatment are crucial (15).…”

Passive cooling to initiate hypothermia for transported encephalopathic newborns

“…[1][2][3][4] This time limit was determined from animal studies that noted decreased efficacy as time from insult to cooling increased, and is based on the onset of secondary energy failure. 5 Given that significant hypoxic-ischemic events may occur well before delivery, the potential therapeutic window in babies may be less, perhaps much less, than 6 h. For children born at referring hospitals, hypothermia can be started at one of three distinct times; as soon as criteria for acute encephalopathy are met (phase I), on arrival of the transport team (phase II), or on arrival at the receiving center (phase III).…”

“…Both the Eicher et al study and the recently completed, as yet unpublished, TOBY trial allow cooling after assessment by the transport team (phase II). 1,4 Eicher et al 1 used cloth covered ice packs to actively cool patients. Outborn patients in the TOBY trial were allowed to cool passively by turning the radiant warmer off.…”

“…[1][2][3] Because of the concern that efficacy diminishes as time from insult to cooling increases, clinical trials have mandated initiation of cooling by 6 h of age. Although appropriate for efficacy trials, these guidelines may not be possible in those clinical situations where active cooling devices are unavailable on short notice.…”

Hypothermia for the treatment of infants with hypoxic–ischemic encephalopathy

“…38 Initial pilot studies in human newborns described reproducible approaches to both selective head and whole-body hypothermic therapy and confirmed the feasibility of such therapies. [39][40][41][42][43][44] Although these studies noted mild physiological changes in cardiovascular status and the potential for minor permutations in coagulation measurements, they showed that these changes were not clinically significant, that both methods of cooling were practical and that there were no major short-term consequences or complications to either method of cooling. On the basis of these pilot studies, larger clinical trials in newborns (described below) have been performed.…”