Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial

Robertson, Nicola J.; Nakakeeto, Margaret; Hagmann, Cornelia; Cowan, Frances; Acolet, Dominique; Iwata, Osuke; Allen, Elizabeth; Elbourne, Diana; Costello, Anthony; Jacobs, Ian

doi:10.1016/s0140-6736(08)61329-x

Cited by 160 publications

(144 citation statements)

References 10 publications

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“…In addition, a high mortality rate was seen in cooled infants in a cooling feasibility study carried out in a Ugandan hospital where high rates of chorioamnionitis and funisitis have been reported in encephalopathic neonates. 51 Previous studies have shown an association between inflammation of the placental villous tree (villitis) and neonatal encephalopathy, but the mechanisms underlying this association are poorly understood. 15,21 Villitis is most frequently of unknown aetiology and is characterized by mixed lymphohistiocytic infiltration of the placenta by maternal CD-8-positive T-lymphocytes.…”

Section: Observations On Placental Pathologymentioning

confidence: 99%

Inflammation‐induced sensitization of the brain in term infants

Fleiss

Tann

Degos

et al. 2015

Develop Med Child Neuro

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COXPerinatal insults are a leading cause of infant mortality and amongst survivors are frequently associated with neurocognitive impairment, cerebral palsy (CP), and seizure disorders. The events leading to perinatal brain injury are multifactorial. This review describes how one subinjurious factor affecting the brain sensitizes it to a second injurious factor, causing an exacerbated injurious cascade. We will review the clinical and experimental evidence, including observations of high rates of maternal and fetal infections in term-born infants with neonatal encephalopathy and cerebral palsy. In addition, we will discuss preclinical evidence for the sensitizing effects of inflammation on injuries, such as hypoxia-ischaemia, our current understanding of the mechanisms underpinning the sensitization process, and the possibility for neuroprotection. PERINATAL BRAIN INJURY IN THE TERM-BORN INFANTIntrapartum neonatal deaths are the third leading cause of global childhood mortality. 1 In addition, each year perinatal insults are estimated to be responsible for more than one million new cases of neonatal encephalopathy, and nearly half a million infants with impairments such as cerebral palsy (CP).2 Infants exposed to a perinatal insult typically present with encephalopathy, a descriptive term for a clinical constellation of neurological dysfunctions in the term-born that includes difficulty with initiating and maintaining respiration; depression of tone and reflexes; subnormal levels of consciousness; and seizures.3 Whilst often assumed to result solely from acute intrapartum hypoxic-ischaemia, the precise contribution of hypoxia is likely to vary according to the definition of encephalopathy used, the range of competing risks, and the care setting. 3,4 Presumed hypoxia-ischaemia is diagnosed based on reduced Apgar scores and acidosis, 5 and the combination of progressive hypoxia, hypercarbia, and acidosis is often referred to as asphyxia. 6 Encephalopathy resulting from hypoxia-ischaemia can be clearly diagnosed only in a small number of cases in which a sentinel event, such as placental abruption, uterine rupture, cord prolapse, or shoulder dystocia, is clearly present. Clinical studies have identified a number of other important antepartum and intrapartum risk factors for neonatal encephalopathy. [7][8][9][10] In low-income settings, where access to skilled birth attendants and emergency obstetric intervention is often limited, the probability of intrapartum hypoxic events contributing to neonatal encephalopathy is increased.2,9,11 However, in general, neonatal encephalopathy is likely to be a multifactorial condition with complex aetiology, encompassing several causal events, with strong evidence that fetal exposure to infection contributes. 12 CONCEPT OF INFLAMMATION-INDUCED SENSITIZATIONAn increasingly common model for the complex and multifactorial process of perinatal brain injury involves sensitization, 13-15 whereby factors not severe enough by themselves to induce significant brain damage make the developi...

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Section: Observations On Placental Pathologymentioning

confidence: 99%

Inflammation‐induced sensitization of the brain in term infants

Fleiss

Tann

Degos

et al. 2015

Develop Med Child Neuro

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“…The efficacy of TH in lowresource settings is unproven, and may be reduced because of inefficiency of the cooling devices, suboptimal intensive care, or intrinsic differences in the populations served [67,68]. While studies from LMICs have established the safety and feasibility of TH in intensive care settings [69,70], a meta-analysis of randomized trials from LMICs, including 567 infants, showed no significant reduction in neonatal mortality (RR 0.74; 95% CI 0.44-1.25) [71]. However, the confidence intervals were wide, with the effect size compatible with results from high-income countries.…”

Section: Therapeutic Hypothermia (Th)mentioning

confidence: 99%

Preventing deaths from complications of labour and delivery

Buchmann

Stones

Thomas

2016

Best Practice & Research Clinical Obstetrics & Gynaecol

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The process of labour and delivery remains an unnecessary and preventable cause of death for women and babies around the world. Although rates of maternal and perinatal death are declining, there are large disparities between rich and poor countries, and sub-Saharan Africa has not seen the scale of declines shown elsewhere. In many areas, maternity services remain sparse and underequipped, with insufficient and poorly trained staff. Priorities for reducing the mortality burden are provision of safe caesarean section, prevention of sepsis, and appropriate care of women in labour in line with current best practices, appropriately and affordably delivered. A concern is that largescale recourse to caesarean delivery has its own dangers and may present new dominant causes for maternal mortality. An area of current neglect is newborn care. However, innovative training methods and appropriate technologies offer opportunities for affordable and effective newborn resuscitation and follow-up management in low-income settings.

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“…Deben ser utilizados dispositivos de hipotermia moderada, equipados con una manta base de temperatura servocontrolada. Están descritos otros dispositivos, tales como botellas de agua 21,22 , ventilador de aire 23 , bolsas de gel refrigerado 6 .…”

Section: Métodos Y Temperatura Objetivounclassified

Consenso sobre manejo integral del neonato con encefalopatía hipóxico isquémica

et al. 2012

Rev. chil. pediatr.

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Consensus statement on integral management of the newborn with hypoxic-ischemic encephalopathyNeonatal encephalopathy secondary to birth asphyxia, the hypoxic ischemic encephalopathy, remains a major cause of postnatal death and neurological sequelae worldwide. supportive therapy has been the mainstay of treatment. Recently series of multicenter clinical trials show the benefits of therapeutic hypothermia in this high risk population. The International liaison Committee on Resuscitation (IlCOR) has recommended hypothermia as a standard of care and a beneficial therapy using the protocols followed in large clinical trials. Our objective was to develop a practical guide to be used at a national level in Chile, compatible with published protocols and standardized on an international basis, practical and compatible with the country's situation, and considering an integral management of the asphyxiated neonates, rescue and neuroprotective therapies. In summary, to establish rescue therapies, with the aim objective of support measures that promote cerebral and systemic oxygenation/perfusion, ensuring optimal cellular homeostasis, which are the basis of the rescue measures in asphyxiated neonates. Along with these rescue therapies, the objective is to perform the more beneficial neuroprotective therapy known today, hypothermia. Hypothermia should be conducted in a level 3 Neonatal Intensive Care unit, with multidisciplinary care and standardized protocols and also multidisciplinary follow-up and rehabilitation therapies.

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Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial

Cited by 160 publications

References 10 publications

Inflammation‐induced sensitization of the brain in term infants

Inflammation‐induced sensitization of the brain in term infants

Preventing deaths from complications of labour and delivery

Consenso sobre manejo integral del neonato con encefalopatía hipóxico isquémica

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