The effect of the implementation of therapeutic hypothermia on fluid balance and incidence of hyponatremia in neonates with moderate or severe hypoxic-ischaemic encephalopathy

Prempunpong, Chatchay; Efanov, Ionut; Sant’Anna, Guilherme M.

doi:10.1111/apa.12362

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…Previous randomised controlled trials (RCT) found fluid restriction precipitated hypoglycaemia and hyponatremia, potentially confounding the observed adverse outcomes 4,7 . Anticipation and correction of these electrolyte disturbances gives this study's results with greater validity.…”

Section: Commentarymentioning

confidence: 86%

Does fluid balance affect neurodevelopmental outcomes in hypoxic‐ischaemic encephalopathy?

Bachu

Hariharan

2021

Acta Paediatrica

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Section: Commentarymentioning

confidence: 86%

Does fluid balance affect neurodevelopmental outcomes in hypoxic‐ischaemic encephalopathy?

Bachu

Hariharan

2021

Acta Paediatrica

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“…12 TH may worsen the asphyxia-induced hyponatraemia due to fluid overload. 13 However, hyponatraemia secondary to asphyxia or TH occurs on DOL 4. 12 13 Our cases had hyponatraemia within 3 hours of birth and did not have elevated creatinine suggestive of acute kidney injury, nor did they have elevated fractional excretion of sodium as shown in table 1.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication

et al. 2021

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Misguided encouragement to consume large volumes of water during labour for pain relief results in dilutional hyponatraemia in mothers and their babies presenting with neurological dysfunction. We report three babies who were encephalopathic with seizures in the background of hyponatraemia secondary to maternal ingestion of large volumes of water and mild perinatal asphyxia. All babies underwent therapeutic hypothermia in addition to sodium supplementation with fluid restriction. Their neurodevelopment was appropriate for age. This case series highlights the dilemma that could arise with hyponatraemic encephalopathy and mild perinatal asphyxia in the first 6 hours of life, which is the window of opportunity for therapeutic hypothermia for hypoxic-ischaemic encephalopathy. It is important to educate pregnant mothers in labour on the adverse effects of excessive fluid ingestion.

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“…Further prospective studies similar to ours are needed. Fluid and electrolyte balance during TH is an important challenge [39]. Cooling can cause peripheral vasoconstriction, reduce vascular volume and CVP, and the patient seems relatively hypovolemic [40].…”

Section: Discussionmentioning

confidence: 99%

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation

et al. 2014

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BackgroundHypothermia has been used in cardiac surgery for many years for neuroprotection. Mild hypothermia (MH) [body temperature (BT) kept at 32–35°C] has been shown to reduce both mortality and poor neurological outcome in patients after cardiopulmonary resuscitation (CPR). This study investigated whether patients who were expected to benefit neurologically from therapeutic hypothermia (TH) also had improved cardiac function.MethodsThe study included 30 patients who developed in-hospital cardiac arrest between September 17, 2012, and September 20, 2013, and had return of spontaneous circulation (ROSC) following successful CPR. Patient BTs were cooled to 33°C using intravascular heat change. Basal BT, systolic artery pressure (SAP), diastolic artery pressure (DAP), mean arterial pressure (MAP), heart rate, central venous pressure, cardiac output (CO), cardiac index (CI), global end-diastolic volume index (GEDI), extravascular lung water index (ELWI), and systemic vascular resistance index (SVRI) were measured at 36°C, 35°C, 34°C and 33°C during cooling. BT was held at 33°C for 24 hours prior to rewarming. Rewarming was conducted 0.25°C/h. During rewarming, measurements were repeated at 33°C, 34°C, 35°C and 36°C. A final measurement was performed once patients spontaneously returned to basal BT. We compared cooling and rewarming cardiac measurements at the same BTs.ResultsSAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). DAP values during rewarming (basal temperature, 34°C, 35°C and 36°C) were lower than during cooling. MAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). CO and CI values were higher during rewarming than during cooling. GEDI and ELWI did not differ during cooling and rewarming. SVRI values during rewarming (34°C, 35°C, 36°C and basal temperature) were lower than during cooling (P < 0.05).ConclusionsTo our knowledge, this is the first study comparing cardiac function at the same BTs during cooling and rewarming. In patients experiencing ROSC following CPR, TH may improve cardiac function and promote favorable neurological outcomes.

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The effect of the implementation of therapeutic hypothermia on fluid balance and incidence of hyponatremia in neonates with moderate or severe hypoxic-ischaemic encephalopathy

Abstract: In our centre, the implementation of TH was followed by an increased fluid retention and higher incidence of hyponatremia. Centres adopting TH should have clear guidelines for fluid and electrolyte management.

Cited by 11 publications

References 22 publications

Does fluid balance affect neurodevelopmental outcomes in hypoxic‐ischaemic encephalopathy?

Does fluid balance affect neurodevelopmental outcomes in hypoxic‐ischaemic encephalopathy?

Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation

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