Article

Determinants of outcomes after head cooling for neonatal encephalopathy

Imperial College London, Londinium, England, United Kingdom
PEDIATRICS (Impact Factor: 5.3). 06/2007; 119(5):912-21. DOI: 10.1542/peds.2006-2839
Source: PubMed

ABSTRACT The goal of this study was to evaluate the role of factors that may determine the efficacy of treatment with delayed head cooling and mild systemic hypothermia for neonatal encephalopathy.
A total of 218 term infants with moderate to severe neonatal encephalopathy plus abnormal amplitude-integrated electroencephalographic recordings, assigned randomly to head cooling for 72 hours, starting within 6 hours after birth (with the rectal temperature maintained at 34.5 +/- 0.5 degrees C), or conventional care, were studied. Death or severe disability at 18 months of age was assessed in a multicenter, randomized, controlled study (the CoolCap trial).
Treatment, lower encephalopathy grade, lower birth weight, greater amplitude-integrated electroencephalographic amplitude, absence of seizures, and higher Apgar score, but not gender or gestational age, were associated significantly with better outcomes. In a multivariate analysis, each of the individually predictive factors except for Apgar score remained predictive. There was a significant interaction between treatment and birth weight, categorized as > or =25th or <25th percentile for term, such that larger infants showed a lower frequency of favorable outcomes in the control group but greater improvement with cooling. For larger infants, the number needed to treat was 3.8. Pyrexia (> or =38 degrees C) in control infants was associated with adverse outcomes. Although there was a small correlation with birth weight, the adverse effect of greater birth weight in control infants remained significant after adjustment for pyrexia and severity of encephalopathy.
Outcomes after hypothermic treatment were strongly influenced by the severity of neonatal encephalopathy. The protective effect of hypothermia was greater in larger infants.

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Available from: Marianne Thoresen, Aug 01, 2015
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    • "These clinical trials indicated that hypothermia can have moderate beneficial effects when the intervention is started within 6 h after the insult in term infants with mild HI damage. Unfortunately, there is little benefit in infants with severe HI brain damage (Jacobs et al., 2007; Wyatt et al., 2007). In addition, hypothermia has not been used in preterm infants. "
    Brain Behavior and Immunity 08/2010; 24. DOI:10.1016/j.bbi.2010.07.029 · 6.13 Impact Factor
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    • "These animal data are strongly supported by clinical observations. Relatively high body temperatures of infants during usual care after hypoxia–ischemia are associated with increased risk of adverse outcomes [16] [36]. "
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    • "Higher core temperatures were associated with significant increases in risk of death or impairment in the control group (Laptook et al., 2008). In a secondary analysis of the Cool Cap trial, investigators also noted an association between elevated temperatures in the control group and increased risk of death or disability (Wyatt et al., 2007). Hyperthermia after brain injury adds to the risk of more severe neurologic damage, and studies in adults and pediatric subjects consistently support association between higher core temperatures and worse outcome (Dietrich and Bramlett, 2007; Bramlett and Dietrich, 2007). "
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    ABSTRACT: In this article, the role of hypothermia and neuroprotection for neonatal encephalopathy will be discussed. The incidence of encephalopathy due to hypoxia ischemia as well as the pathophysiology will be presented. The diagnosis of encephalopathy in full-term neonates will be discussed. The current management of brain injury that occurs with hypoxia ischemia and the role of hypothermia in preventing brain injury in fetal and neonatal animal models will be reviewed. The current data from randomized control trials of hypothermia as neuroprotection for full-term infants will be presented along with the results of meta-analyses of these trials. Lastly, the status of ongoing neonatal hypothermia trials will be summarized.
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