Selective Head Cooling with Mild Systemic Hypothermia after Neonatal Hypoxic-Ischemic Encephalopathy: A Multicenter Randomized Controlled Trial in China

Zhou, Wenhao; Cheng, Guoqiang; Shao, Xiaomei; Liu, Xianzhi; Shan, Ruobing; Zhuang, Deyi; Zhou, Chuan; Du, Lizhong; Cao, Yun; Yang, Qun; Wang, Laishuan

doi:10.1016/j.jpeds.2010.03.030

Cited by 274 publications

(246 citation statements)

References 27 publications

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“…7 Other trials of whole-body or head-only cooling with whole-body hypothermia for neonatal encephalopathy have shown beneficial outcomes of hypothermia at 18 to 24 months of age in the entire study cohorts and in selected subgroups. [7][8][9] In the present study assessing children at 6 to 7 years of age, the difference in rates of the composite outcome of death or an IQ score below 70 between hypothermia and usual care did not achieve statistical significance (P = 0.06); however, the previous finding of reduced mortality with hypothermia was maintained, with no appreciable increase in the risk of neurodevelopmental deficits among survivors.…”

Section: Discussioncontrasting

confidence: 71%

Effect of hypothermia for perinatal asphyxia on childhood outcomes

Jose¹,

Ismael²

2017

Int J Contemp Pediatr

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Background: Perinatal asphyxia, neonatal asphyxia or birth asphyxia is the medical condition resulting from deprivation of oxygen to a new born infant that lasts long enough during the birth process to cause physical harm, usually to the brain. This study was performed to evaluate study population who were 6 to 8 years of age to determine whether the application of moderate hypothermia after perinatal asphyxia is associated with long term benefits.Methods: This study was a randomised, controlled trials which consisted of infants who were admitted with moderate and severe encephalopathy within 6 hours after birth after an acute perinatal event, with acidosis or resuscitation. Infants were assigned to undergo whole body hypothermia at 33ºC for 72 hours or to undergo usual care randomly.Results: All maternal baseline characteristics and Neonatal characteristics are non significant in both groups. APGAR score ≤5 is significant at 10mins in comparison. cerebral palsy were 18% and 25%, respectively, the rates of blindness were 1% and 4% the rates of hearing impairment (requiring aids) were 5.4% and 12.8%. There were no significant between-group differences in the level of disability among all survivors or in motor function among the 45 nondisabled children. Among children who had moderate or severe disability at 18 months, the corresponding rates at 6 to 7 years of age were 88% in the hypothermia group and 95% in the control group. All the children who had moderate-to-severe cerebral palsy at 18 months continued to be affected at 6 to 7 years in both groups. There was no significant between-group difference with respect to IQ scores that were measured on a continuous scale and other scores, with the exception of 1 of the 11 scores compared (attention and executive function, P=0.03). There were also no significant differences between groups in mean scores on the index of health care status derived from parental assessments or in parental scores for children’s strengths and difficulties and ADHD The mean difference in the academic achievement score favored the hypothermia group but was not significant.Conclusions: Moderate hypothermia after perinatal asphyxia resulted in improved neurocognitive outcomes in middle childhood.

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Section: Discussioncontrasting

confidence: 71%

Effect of hypothermia for perinatal asphyxia on childhood outcomes

Jose¹,

Ismael²

2017

Int J Contemp Pediatr

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“…Reduction in temperature is achieved by running 10°C water through a coil of tubing wrapped around the infant's scalp for 72 hours [91]. Other studies have showed improvement in short-term computed tomographic changes [92], neurodevelopment outcome at 18 months [5], or combined outcome of severe disability and death [93]. As with other surface cooling methods, some devices are adjusted manually or automatically via a feedback mechanism [93].…”

Section: Cool Caps For Infantsmentioning

confidence: 99%

“…Other studies have showed improvement in short-term computed tomographic changes [92], neurodevelopment outcome at 18 months [5], or combined outcome of severe disability and death [93]. As with other surface cooling methods, some devices are adjusted manually or automatically via a feedback mechanism [93]. Potential adverse events include scalp edema, thrombocytopenia, hypotension, and bradycardia [94].…”

Section: Cool Caps For Infantsmentioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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“…77 What about hypothermia and neonatal brain damage? Creeley and Olney have reported laboratory evidence that hypothermia (30 • C) attenuates anesthesia-induced apoptosis in neonatal mice, 78 and human trials looking at wholebody hypothermia 79 and selective head cooling 80 in neonates with hypoxic-ischemic encephalopathy have found a decrease in death and/or moderate-tosevere disability. And magnesium sulfate?…”

Section: What Might Be Done?mentioning

confidence: 99%

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

Cottrell

Hartung

2012

Mount Sinai J Medicine

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The assumption that anesthesia has no serious, long‐term, adverse central nervous system consequences may be true for most patients between 6 months and 60 years of age. However, for patients younger than 6 months or older than 60 years, that status quo assumption is under challenge from a growing body of evidence. Fetuses and newborns appear to be at risk because systems that would enable them to fully recover from the effects of more than 2 hours of anesthesia are still in development. In distinction, the elderly appear to be at risk because systems that once enabled them to fully recover have ever‐diminishing capacity. Even for those between the age of 6 months and 60 years, full recovery may require replacing apoptosed neurons and pruning overabundant dendritic spines … perhaps leaving patients not quite the same person that they were before they were anesthetized. Mt Sinai J Med 79:75–94, 2012. © 2012 Mount Sinai School of Medicine

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Selective Head Cooling with Mild Systemic Hypothermia after Neonatal Hypoxic-Ischemic Encephalopathy: A Multicenter Randomized Controlled Trial in China

Cited by 274 publications

References 27 publications

Effect of hypothermia for perinatal asphyxia on childhood outcomes

Effect of hypothermia for perinatal asphyxia on childhood outcomes

Therapeutic Hypothermia for Acute Neurological Injuries

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

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