To cool or not to cool? Hypothermia treatment outside trial criteria

Austin, Topun; Shanmugalingam, S; Clarke, Paul

doi:10.1136/archdischild-2012-302069

Cited by 24 publications

(18 citation statements)

References 23 publications

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“…Although therapeutic hypothermia is well accepted for the clinical treatment of cardiological or central nervous system complications [8], at the moment it is not used in humans for diseases of the eye.…”

Section: Introductionmentioning

confidence: 99%

Cold Shock Proteins Are Expressed in the Retina Following Exposure to Low Temperatures

et al. 2016

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Hypothermia has been proposed as a therapeutic intervention for some retinal conditions, including ischemic insults. Cold exposure elevates expression of cold-shock proteins (CSP), including RNA-binding motif protein 3 (RBM3) and cold inducible RNA-binding protein (CIRP), but their presence in mammalian retina is so far unknown. Here we show the effects of hypothermia on the expression of these CSPs in retina-derived cell lines and in the retina of newborn and adult rats. Two cell lines of retinal origin, R28 and mRPE, were exposed to 32°C for different time periods and CSP expression was measured by qRT-PCR and Western blotting. Neonatal and adult Sprague-Dawley rats were exposed to a cold environment (8°C) and expression of CSPs in their retinas was studied by Western blotting, multiple inmunofluorescence, and confocal microscopy. RBM3 expression was upregulated by cold in both R28 and mRPE cells in a time-dependent fashion. On the other hand, CIRP was upregulated in R28 cells but not in mRPE. In vivo, expression of CSPs was negligible in the retina of newborn and adult rats kept at room temperature (24°C). Exposure to a cold environment elicited a strong expression of both proteins, especially in retinal pigment epithelium cells, photoreceptors, bipolar, amacrine and horizontal cells, Müller cells, and ganglion cells. In conclusion, CSP expression rapidly rises in the mammalian retina following exposure to hypothermia in a cell type-specific pattern. This observation may be at the basis of the molecular mechanism by which hypothermia exerts its therapeutic effects in the retina.

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Section: Introductionmentioning

confidence: 99%

Cold Shock Proteins Are Expressed in the Retina Following Exposure to Low Temperatures

et al. 2016

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“…Based on these studies, TH initiated within 6 h of birth has been recommended since 2010 as the standard of care for newborn infants ≥36 weeks gestation and ≥1,800 g birth weight with moderate to severe neonatal encephalopathy910. Now that the technique has become a routine part of clinical practice, it is expected that TH will be used in a broader range of neonates than the recommendations suggest11. Indeed, a survey conducted in 330 North American neonatal intensive care units demonstrated that approximately 30% of the units administered TH to neonates ≤35 weeks gestation12.…”

mentioning

confidence: 99%

Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan

Tsuda

Mukai

Iwata

et al. 2017

Sci Rep

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Therapeutic hypothermia is recommended for moderate and severe neonatal encephalopathy, but is being applied to a wider range of neonates than originally envisaged. To examine the clinical use of therapeutic hypothermia, data collected during the first 3 years (2012–2014) of the Baby Cooling Registry of Japan were analysed. Of 485 cooled neonates, 96.5% were ≥36 weeks gestation and 99.4% weighed ≥1,800 g. Severe acidosis (pH < 7 or base deficit ≥16 mmol/L) was present in 68.9%, and 96.7% required resuscitation for >10 min. Stage II/III encephalopathy was evident in 88.3%; hypotonia, seizures and abnormal amplitude-integrated electroencephalogram were observed in the majority of the remainder. In-hospital mortality was 2.7%; 90.7% were discharged home. Apgar scores and severity of acidosis/encephalopathy did not change over time. The time to reach the target temperature was shorter in 2014 than in 2012. The proportion undergoing whole-body cooling rose from 45.4% to 81.6%, while selective head cooling fell over time. Mortality, duration of mechanical ventilation and requirement for tube feeding at discharge remained unchanged. Adherence to standard cooling protocols was high throughout, with a consistent trend towards cooling being achieved more promptly. The mortality rate of cooled neonates was considerably lower than that reported in previous studies.

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“…In recent years, cooling therapy has become a widely used treatment method in babies with moderate or se- vere HIE (1,3,(22)(23)(24)(25)(26). It is thought that the neuron protecting effects of cooling are related with reduction of brain metabolism rate, stimulating amino acid release, apoptosis, nitric oxide production, lipid peroxidation and limitation of free radical damage (27).…”

Section: Discussionmentioning

confidence: 99%

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

Atıcı¹,

Çelik²,

Gülaşı³

et al. 2015

Turk Arch Ped

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Aim: In this study, it was aimed to investigate which method was superior by applying selective head cooling or whole body cooling therapy in newborns diagnosed with moderate or severe hypoxic ischemic encephalopathy. Material and Methods: Newborns above the 35th gestational age diagnosed with moderate or severe hypoxic ischemic encephalopathy were included in the study and selective head cooling or whole body cooling therapy was performed randomly. The newborns who were treated by both methods were compared in terms of adverse effects in the early stage and in terms of short-term results. Ethics committee approval was obtained for the study (06.01.2010/35). Results: Fifty three babies diagnosed with hypoxic ischemic encephalopathy were studied. Selective head cooling was applied to 17 babies and whole body cooling was applied to 12 babies. There was no significant difference in terms of adverse effects related to cooling therapy between the two groups. When the short-term results were examined, it was found that the hospitalization time was 34 (7-65) days in the selective head cooling group and 18 (7-57) days in the whole body cooling group and there was no significant difference between the two groups (p=0.097). Four patients in the selective head cooling group and two patients in the whole body cooling group were discharged with tracheostomy because of the need for prolonged mechanical ventilation and there was no difference between the groups in terms of discharge with tracheostomy (p=0.528). Five patients in the selective head cooling group and three patients in the whole body cooling group were discharged with a gastrostomy tube because they could not be fed orally and there was no difference between the groups in terms of discharge with a gastrostomy tube (p=0.586). One patient who was applied selective head cooling and one patient who was applied whole body cooling died during hospitalization and there was no difference between the groups in terms of mortality (p=0.665). Conclusions: There is no difference between the methods of selective head cooling and whole body cooling in terms of adverse effects and short-term results. (Türk Ped Arş 2015; 50: 27-36)

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To cool or not to cool? Hypothermia treatment outside trial criteria

Cited by 24 publications

References 23 publications

Cold Shock Proteins Are Expressed in the Retina Following Exposure to Low Temperatures

Cold Shock Proteins Are Expressed in the Retina Following Exposure to Low Temperatures

Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

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