Selective head cooling with hypothermia suppresses the generation of platelet-activating factor in cerebrospinal fluid of newborn infants with perinatal asphyxia

Akısü, Mete; Hüseyinov, Afig; Yalaz, Mehmet; Çetin, Hasan; Kültürsay, Nilgün

doi:10.1016/s0952-3278(03)00055-3

Cited by 86 publications

(57 citation statements)

References 28 publications

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“…5,15 After extensive experiments in animal models, several pilot or small clinical trials using hypothermia for neuroprotection in asphyxiated full-term infants have been performed. 8,9,[16][17][18][19] From those pilot human studies it appears that mild hypothermia is safe when used in term infants with perinatal asphyxia as long as close monitoring can be implemented in the NICU setting. With our particular setting and patient population, we are able to demonstrate in this randomized intent-to-treat clinical trial that mild hypothermia for 72 h via selective head cooling started within 6 h of perinatal asphyxia can significantly attenuate the brain injury based on the head CT scan and NBNA score changes at about 1 week of life.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] A few small clinical trials have demonstrated the safety of head cooling when used in neonates with HIE. 8,9 The purpose of this study was to use this simple method to treat full-term infants with perinatal asphyxia and examine its measurable efficacy compared to a control group that received routine treatment.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, routine use of dopamine for asphyxiated term infants is not a common practice. Based on our experience with asphyxiated infants, as well as reported hemodynamic and renal perfusion changes in other studies, 8,9,27 we decided to use dopamine at 5 mg/kg/min for all enrolled patients to prevent hypothermiarelated adverse hemodynamic changes, and as an attempt to improve renal blood flow.…”

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confidence: 99%

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Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

Zl¹,

et al. 2006

J Perinatol

118

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Objective: The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia.Study design: Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5-7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7-10 days of life.Results: A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (w 2 ¼ 15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32±2 in the hypothermic group vs 28±3 in the control group, P<0.01). Conclusions:Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

Zl¹,

et al. 2006

J Perinatol

118

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“…Günümüzde bildirilen son çalışmalarda HİE'li bebeklerde beyin omurilik sıvısında PAF ve interlökin 6 düzeyinin arttığı, her iki göstergenin mortalite ve morbidite gelişiminde önemli role sahip olduğu bildirilmiştir (10,11). HİE'li bebeklerde sadece başa uygulanacak soğuk uygulama ile birlikte tüm vücutta hafif bir hipotermi sağlamanın (rektal ateş 36-36.5 derece), BOS sıvısında PAF düzeyini azaltarak mortaliteyi azalttığı bildirilmiştir (11).…”

Section: Discussionunclassified

“…HİE'li bebeklerde gelişen çoklu organ hasarının derecesini saptamak ve mortalite ilişkisini belirlemek amacıyla yapılan çalışmalarda laboratuar testlerinin [serumda ve idrarda S100 B proteini, beyin omurilik sıvısında (BOS) platelet-activating factor (PAF), interlökin 6 ve nöron spesifik enolaz düzeyi, serebral kan akımı hızı, aktivin A, kan glukoz düzeyi, laktat dehidrojenaz (LDH), aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), kreatin kinaz miyokard bandı (CK-MB), Troponin-T ve Troponin-I] mortalite ile ilişkisi konusunda kesin bir sonuca varılamamıştır (6,11).…”

Section: Introductionunclassified

The Evaluation Of The Association Of Laboratory Tests Associated With Mortality In Term Neonates With Hypoxic-ischemic Encephalopathy

Can¹,

Bülbül²,

Nuhoğlu³

2010

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ÖZETAmaç: Hipoksik iskemik ensefalopati (HİE) tanılı zamanında doğan yenidoğan bebeklerin erken dönem laboratuvar testlerinin mortalite ile ilişkisinin değerlendirilmesi. Gereç ve Yöntemler: Ocak 2004-Aralık 2008 tarihleri arasında HİE tanısı alan yenidoğan bebekler; yaşayan ve ölen olarak iki gruba ayırılarak prospektif olarak incelendi.Bulgular: Çalışmaya 32 yenidoğan alındı. Sarnat&Sarnat'a göre bebeklerin 9'u (%28.1) evre 1, 14'ü (%43.8) evre 2 ve 9'u (%28.1) evre 3 idi. Bebeklerin 8'i (%25) kaybedildi. Risk faktörlerinin korelasyon değerlendirme-sinde; antenatal takipsizlik (r²=0.35) ve konvülsiyon geçirmenin (r²=0.50) Sarnat evresi ile, Sarnat evresinin de mortalite ile pozitif ilişkili olduğu saptandı (r²=0.57). Laboratuvar testlerinde CK-MB ölüm oranı ile kuvvetli ilişkili (r²=0.74), troponin-I orta düzeyde ilişkili (r²=0.44), pH ise zayıf ilişkili bulundu (r²=0.27). Mortalite için CK-MB ve Troponin-I seviyelerinin prediktivitesinin yüksek, pH'nın ise orta dereceli olduğu saptandı. CK-MB'nin mortalite için duyarlılığı %100, özgüllüğü %91.6; Troponin-I'nın mortalite için duyarlılığı %100 ve özgüllüğü %70.8; pH'nın mortalite için duyarlılığı %75 ve özgüllüğü %87.5 bulundu.Sonuç: HİE tanılı zamanında doğmuş yenidoğan bebeklerde, erken dö-nem ölüm oranlarının, CK-MB değeri ile yüksek, Troponin-I değeri ile orta ve pH değeri ile zayıf ilişkili olduğu saptandı.Anahtar Sözcükler: Hipoksik-iskemik ensefalopati, mortalite, CK-MB, troponin-I, yenidoğan The evaluation of the relationships between the mortality and early period laboratory tests in the term infants diagnosed as hypoxic ischemic encephalopathy (HIE). Material and Methods:The newborns diagnosed as HIE between January 2004 and December 2008 were divided into two groups as the living and non-surviving groups. The two groups were evaluated prospectively.Results: Thirty two infants were included in the study. According to the Sarnat&Sarnat classification, 9 (28.1%), 14 (43.8%) and 9 infants (28.1%) were in stage 1, 2 and 3, respectively. Eight (25%) infants died. In the correlation evaluation of risk factors; lack of-follow-up at the antenatal period (r²=0.35) and having convulsions (r²=0.50) were positively associated with Sarnat stage. A positive relationship between Sarnat stage and the mortality rate was also determined (r²=0.57). CK-MB was strongly (r²=0.74), troponin-I moderately (r²=0.44), and pH weakly (r²=0.27) associated with mortality. In predicting mortality, the sensitivity and specificity for CK-MB was 100% and 91.6%, for Troponin I 100% and 70.8% and for pH 75% and 87.5%, respectively. Conclusion:This study demonstrates that in HIE, the relationship between the early period mortality rate and CK-MB values are strong, whereas for troponin-I and pH there is a moderate and weak association respectively.Key Words: Hypoxic-ischemic encephalopathy, mortality, CK-MB, troponin I, newborn : 28.01.2010: 28.01. Accepted: 07.05.2010 Giriş Hipoksik iskemik ensefalopati (HİE) intrapartum hipoksi veya geç antepartum serebral hipoksi ve iskeminin neden ol...

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Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy

Shah¹,

Ohlsson²,

Perlman³

2007

Arch Pediatr Adolesc Med

166

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Selective head cooling with hypothermia suppresses the generation of platelet-activating factor in cerebrospinal fluid of newborn infants with perinatal asphyxia

Cited by 86 publications

References 28 publications

Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

The Evaluation Of The Association Of Laboratory Tests Associated With Mortality In Term Neonates With Hypoxic-ischemic Encephalopathy

Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy

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