Hypothermia for neonatal hypoxic ischemic encephalopathy using axillary temperature: an effective treatment in a low resource setting
DOI:
https://doi.org/10.5902/2236583421284Keywords:
Hypoxia-Ischemia, Brain, Hypothermia, Induced, NewbornAbstract
Therapeutic hypothermia is the standard clinical practice for neonates with moderate to severe hypoxic ischaemic encephalopathy (HIE). Aim: To implement a therapeutic hypothermia protocol using axillary temperature in newborns with HIE, comparing the short term outcomes with a historical control group. Methods: Non-randomized clinical trial. Infants born at 36 weeks gestation with perinatal asphyxia were included in the study. An hypothermia protocol was applied in all neonates diagnosed with HIE admitted to the NICU. Results: Six newborns underwent therapeutic hypothermia and their clinical outcomes were compared with 18 newborns admitted previously (control group). Mortality was lower in hypothermia group as well as the presence of disabilities in hospital discharge. Conclusion: Therapeutic hypothermia for treatment of HIE in newborn infants seems to be a safe and effective procedure having a significant impact in reducing the mortality rate and improving the neurodevelopmental in short term.
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Fonseca LF, Xavier C, Pianetti G. Compêndio de Neurologia Infantil. 2a ed. Rio de Janeiro: Medbook; 2011.
Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013 Jan;1:CD003311.
Shankaran S, Laptook AR, Ehrenkranz R a, Tyson JE, McDonald S a, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005 Oct 13;353(15):1574–84.
Edwards a D, Brocklehurst P, Gunn a. J, Halliday H, Juszczak E, Levene M, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and metaanalysis of trial data. BMJ. 2010 Feb 9;340(feb09 3):c363–c363.
Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011 Aug;165(8):692–700.
Tagin M a, Woolcott CG, Vincer MJ, Whyte RK, Stinson D a. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012 Jun 1;166(6):558–66.
Simbruner G, Mittal R a, Rohlmann F, Muche R. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics. 2010 Oct;126(4):e771–8.
Zhou W, Cheng G, Shao X, Liu X, Shan R, Zhuang D, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010 Sep;157(3):367–72, 372.e1–3. ISSN 2236-5834 electroencephalographic study. Arch Neurol. 1976 Oct;33(10):696–705.
Dubowitz L, Mercuri E, Dubowitz V. An optimality score for the neurologic examination of the term newborn. J Pediatr. 1998 Sep;133(3):406–16.
Craig J V, Lancaster G a, Williamson PR, Smyth RL. Temperature measured at the axilla compared with rectum in children and young people: systematic review. BMJ (Clinical research ed.) [Internet]. 2000 Apr 29;320(7243):1174– 8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27359&tool=pmcentrez&rendertype=abstract
Horn a R, Harrison MC, Linley LL. Can skin temperature replace. Journal of tropical pediatrics [Internet]. 2010 Jun [cited 2014 Mar 27];56(3):172–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19793894
Thomas N, Rebekah G, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Can skin temperature replace rectal temperature monitoring in babies undergoing therapeutic hypothermia in low-resource settings? Acta paediatrica (Oslo, Norway : 1992) [Internet]. 2012 Dec [cited 2014 Mar 27];101(12):e564–7. Available from: http://www.ncbi.nlm.nih.gov/
pubmed/23013463
Thomas N, George KC, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting: a feasibility trial. Indian Pediatr. 2011;48 445-451.
Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards a D, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365(9460):663– 70.
Azzopardi D V, Strohm B, Edwards a D, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to
treat perinatal asphyxial encephalopathy. N Engl J Med. 2009 Oct 1;361(14):1349–58.
