Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study

Abstract

Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study Hipotermia corpórea neuroprotetora em recém-nascidos com encefalopatia hipóxico-isquêmica: três anos de experiência em hospital universitário terciário. Um estudo observacional retrospectivo ABSTRACTCONTEXT AND OBJECTIVE: Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that therapeutic hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns. DESIGN AND SETTING: Retrospective study, conducted in a university hospital. METHODS: Thirty-five patients with perinatal asphyxia undergoing body cooling between May 2009 and November 2012 were evaluated. RESULTS: Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The main complication was infection, diagnosed in seven mothers (20%) and 14 newborns (40%). Convulsions occurred in 15 infants (43%). Thirty-one patients (88.6%) required mechanical ventilation and 14 of them (45%) were extubated within 24 hours. The duration of mechanical ventilation among the others was 7.7 days. The cooling protocol was started 1.8 hours after birth. All patients showed elevated levels of creatine phosphokinase, creatine phosphokinase-MB and lactate dehydrogenase. There was no severe arrhythmia; one newborn (2.9%) presented controlled coagulopathy. Four patients (11.4%) presented controlled hypotension. Twenty-nine patients (82.9%) underwent cerebral ultrasonography and 10 of them (34.5%) presented white matter hyper-echogenicity. Brain magnetic resonance imaging was performed on 33 infants (94.3%) and 11 of them (33.3%) presented hypoxic-ischemic changes. The hospital stay was 23 days. All newborns were discharged. Two patients (5.8%) needed gastrostomy. CONCLUSION: Hypothermia as therapy for asphyxiated newborns was shown to be safe. Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study | ORIGINAL ARTICLE Sao Paulo Med J. 2015; 133(4):314-9 315 RESUMO

Relevance of urinary S100B protein levels as a short-term prognostic biomarker in asphyxiated infants treated with hypothermia

“…[ 7 , 8 ] The neuroprotective strategy of therapeutic hypothermia involves the modulation of inflammatory cascade inhibition, reduced production of reactive oxygen species, and a reduction in metabolic rate. [ 9 – 12 ]…”

Effectiveness of reaching and maintaining therapeutic hypothermia target temperature using low‐cost devices in newborns with hypoxic–ischemic encephalopathy

“…This study describes 8 years of experience with the use of ice packs in whole body TH in newborns with HIE in a Tertiary University Hospital in Brazil (Magalhães et al, 2014). In a national survey, using social media, on the use of TH, it was observed that 38% of 411 health care professionals surveyed reported not using this therapy in HIE at the neonatal units they work at.…”

“…However, the safety and effectiveness of TH in low‐ and middle‐income countries still unknown (Pauliah, Shankaran, Wade, Cady, & Thayyil, 2013), especially with the use of alternative devices for cooling, such as ice packs, cold water bottles, mattresses made of phase change materials and low‐cost servo‐controlled cooling blankets (Prashantha et al, 2019; Robertson et al, 2008; Rossouw, Irlam, & Horn, 2015; Thomas et al, 2011). The Neonatology Service of Santa Casa de São Paulo started the whole‐body cooling program in newborns with HIE using ice packs in 2009 (Magalhães et al, 2014). The primary objective of this study was to evaluate the feasibility and effectiveness of using low‐cost devices (ice packs) to reach and maintain the TH target temperature in newborns with moderate or severe HIE using low‐cost devices in a limited resource setting, by analyzing the rectal temperature curves during the cooling period.…”

Asociación entre concentraciones séricas de lactato deshidrogenasa en las primeras 12 horas de vida y encefalopatía hipóxico-isquémica. Estudio preliminar

“…[14][15][16] En estudios previos, la elevación de la aminotransferasa de alanina en el recién nacido ha demostrado una alta especificidad para predecir el riesgo de encefalopatía hipóxico-isquémica, mientras que un incremento en la lactato deshidrogenasa resulta un marcador altamente sensible para daño celular. [15][16][17] El incremento en las concentraciones séricas de estas enzimas, así como sus patrones diferenciados de aclaramiento en plasma, pueden servir como marcadores predictivos de encefalopatía hipóxico-isquémica en neonatos con signos de sufrimiento fetal en el periparto. 1,[15][16][17] La importancia de establecer el diagnóstico oportuno de la asfixia neonatal radica en la posibilidad de efectuar ciertos procedimientos terapéuticos que reducen la probabilidad de que el neonato tenga secuelas neurológicas, en particular la hipotermia terapéutica; sin embargo, las ventajas neuroprotectoras de esta medida disminuyen rápidamente si se retrasa su aplicación, solo habiéndose demostrado ventaja si se inicia en las 6 horas posteriores al evento de asfixia.…”

“…[15][16][17] El incremento en las concentraciones séricas de estas enzimas, así como sus patrones diferenciados de aclaramiento en plasma, pueden servir como marcadores predictivos de encefalopatía hipóxico-isquémica en neonatos con signos de sufrimiento fetal en el periparto. 1,[15][16][17] La importancia de establecer el diagnóstico oportuno de la asfixia neonatal radica en la posibilidad de efectuar ciertos procedimientos terapéuticos que reducen la probabilidad de que el neonato tenga secuelas neurológicas, en particular la hipotermia terapéutica; sin embargo, las ventajas neuroprotectoras de esta medida disminuyen rápidamente si se retrasa su aplicación, solo habiéndose demostrado ventaja si se inicia en las 6 horas posteriores al evento de asfixia. [17][18][19][20][21][22][23] El objetivo del estudio fue: analizar la posible asociación entre el cambio en los valores séricos de lactato deshidrogenasa con respecto a distintos intervalos en las primeras 12 horas de vida extrauterina y la encefalopatía hipóxicoisquémica en recién nacidos con factores de riesgo para asfixia neonatal.…”