The effect of whole body cooling in asphyxiated neonates with resource limitation: Challenges and experience

Sinha, Rahul; Venkatnarayan, Kavitha; Negi, Vandana; Sodhi, Kirandeep; John, BM

doi:10.4103/jcn.jcn_59_17

Cited by 3 publications

(7 citation statements)

References 1 publication

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Section: Diagnosismentioning

confidence: 99%

“…An HIE diagnosis is multifactorial, and it is based upon a combination of maternal/perinatal history, thorough physical and neurological assessments, laboratory results, and imaging [2]. The healthcare team must rule out potential diagnoses that have similar manifestations such as inborn errors of metabolism, infection, stroke, genetic anomalies, subgaleal hemorrhage, and congenital neuromuscular disorders [2]. Laboratory testing includes a complete blood count (CBC) to assess for infection and/or thrombocytopenia, blood cultures to rule out infection, a comprehensive metabolic panel (CMP) to assess for electrolyte imbalances, hypoglycemia, and liver or kidney damage as evidenced by blood urea nitrogen (BUN), creatinine, and liver enzyme levels.…”

Section: Diagnosismentioning

confidence: 99%

“…Laboratory testing includes a complete blood count (CBC) to assess for infection and/or thrombocytopenia, blood cultures to rule out infection, a comprehensive metabolic panel (CMP) to assess for electrolyte imbalances, hypoglycemia, and liver or kidney damage as evidenced by blood urea nitrogen (BUN), creatinine, and liver enzyme levels. Additional laboratory testing consists of an ammonia test, a lactate level, and a disseminated intravascular coagulation (DIC) panel [2].…”

Section: Diagnosismentioning

confidence: 99%

“…necessitating the need for respiratory support [1]. The hypoxic ischemic event can cause hypoxemia, hypercapnia, electrolyte disturbances, and metabolic acidosis, which ultimately lead to encephalopathy and organ dysfunction that negatively impacts liver and renal function [2]. Obstruction of cerebral blood flow is the primary cause of the events associated with HIE, which can lead to progressive injury.…”

mentioning

confidence: 99%

“…Brain damage associated with HIE occurs either in the cortical region or in deeper brain structures such as the basal ganglia and/or thalamus. Depending on the degree of brain damage, the neonate can present with hearing loss, learning disabilities, motor dysfunction, cerebral palsy, and death [2]. The pathophysiologic results of hypoxic ischemic injuries are complicated; however, medical professionals now better understand the disease process.…”

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confidence: 99%

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Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia

A¹

2022

Clin Pediatr Res

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Hypoxic ischemic encephalopathy (HIE) is a brain injury caused by inadequate cerebral blood flow, which occurs secondary to a hypoxic ischemic event during the prenatal, intrapartum, or postpartum time periods. Prime examples of hypoxic ischemic injuries can be divided into two categories: maternal risk factors and perinatal risk factors. Maternal risk factors include thromboembolic disorders, hypertension, infection, placental abnormalities, and illicit drug use. Perinatal risk factors include placental abruption, uterine rupture, cord prolapse, placenta previa, shoulder dystocia, etc. Severity ranges from mild with a full recovery to severe with long-term adverse outcomes. This is a serious complication of full term birth that affects approximately 1.5 to 2.5 neonates per one thousand live births [1]. In fact, an estimated 60% of infants affected by HIE will experience disabilities such as epilepsy, mental impairments, and cerebral palsy. Therapeutic hypothermia or body cooling, which decreases the metabolic demands of the body and minimizes brain sequelae, is a treatment option for neonates who meet specific inclusion criteria. PresentationClinical manifestations of HIE typically present within the postpartum period. Manifestations include abnormal heart rate tracings, abnormal arterial blood gas results, low APGAR scores, meconium stained amniotic fluid, decreased tone, depressed reflexes, seizure activity, and resuscitation

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia

A¹

2022

Clin Pediatr Res

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Post-Asphyxial Aftercare and Management of Neonates in Low- and Middle-Income Countries: A Systematic Evidence Synthesis

Muralidharan,

Rehman,

Sihota

et al. 2024

Neonatology

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Introduction: Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs). Methods: Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews. Results: Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities. Conclusion: The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift toward prevention, and strategies that emphasize improving antenatal and obstetric care.

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Early Clinical Outcome and Complications Associated in Neonates with Hypoxic Ischemic Encephalopathy Grade II/III who Underwent Treatment with Servo Controlled Whole-Body Therapeutic Hypothermia

Phadke¹,

Kumble²,

Ravikumar³

2021

Journal of Clinical Neonatology

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Background: There are limited data regarding servo-controlled whole-body therapeutic hypothermia (TH) for neonates with hypoxic-ischemic encephalopathy (HIE) Stage II/III in the Indian setting. The objectives of this study were to determine the early clinical outcome of neonates with HIE Stage II/III treated with TH and to determine the mortality rate and associated complications. Methods: This study was a prospective observational study done at a Level 3A National Neonatology Forum accredited tertiary care neonatal intensive care unit (NICU). Term neonates with HIE Grade II/III admitted to NICU within 6 h of birth were enrolled in the study. Subjects underwent servo-controlled whole-body therapeutic cooling as per the research protocol. Results: Out of 54 subjects, 22 (40.7%) had stage II HIE and 32 (59.3%) had Stage III. The mortality rate was 24% (n = 13), with all having Stage 3. Direct breastfeeds was achieved in 65.9% of successfully cooled babies within 48 h after TH treatment. About 85.4% of babies who were successfully cooled had good early clinical outcomes as evidenced by good activity, normal tone, successful direct breastfeeding, and early discharge within 72 h post treatment with TH. Coagulopathy was observed in 70.4%, raised liver enzymes in 96.3% and thrombocytopenia in 9.3%. Conclusion: There is a significant correlation of grade of encephalopathy and blood gas abnormality at admission with the outcome in babies with HIE treated with TH. Majority of babies with HIE stage 2/3 who successfully completed TH had good early clinical outcomes at the time of discharge.

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The effect of whole body cooling in asphyxiated neonates with resource limitation: Challenges and experience

Cited by 3 publications

References 1 publication

Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia

Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia

Post-Asphyxial Aftercare and Management of Neonates in Low- and Middle-Income Countries: A Systematic Evidence Synthesis

Early Clinical Outcome and Complications Associated in Neonates with Hypoxic Ischemic Encephalopathy Grade II/III who Underwent Treatment with Servo Controlled Whole-Body Therapeutic Hypothermia

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