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Randomized Controlled Trial
. 2008 Sep;122(3):491-9.
doi: 10.1542/peds.2007-1673.

Elevated temperature after hypoxic-ischemic encephalopathy: risk factor for adverse outcomes

Abbot Laptook  1 , Jon Tyson, Seetha Shankaran, Scott McDonald, Richard Ehrenkranz, Avroy Fanaroff, Edward Donovan, Ronald Goldberg, T Michael O'Shea, Rosemary D Higgins, W Kenneth Poole; National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Randomized Controlled Trial

Elevated temperature after hypoxic-ischemic encephalopathy: risk factor for adverse outcomes

Abbot Laptook et al. Pediatrics. 2008 Sep.

Abstract

Objective: The goal was to determine whether the risk of death or moderate/severe disability in term infants with hypoxic-ischemic encephalopathy increases with relatively high esophageal or skin temperature occurring between 6 and 78 hours after birth.

Methods: This was an observational secondary study within the National Institute of Child Health and Human Development Neonatal Research Network randomized trial comparing whole-body cooling and usual care (control) for term infants with hypoxic-ischemic encephalopathy. Esophageal and skin temperatures were recorded serially for 72 hours. Each infant's temperatures for each site were rank ordered. The high temperature was defined for each infant as the mean of all temperature measurements in the upper quartile. The low temperature was similarly defined as the mean of the lower quartile. Outcomes were related to temperatures in 3 logistic regression analyses for the high, median, and low temperatures at each temperature site for each group, with adjustment for the level of encephalopathy, gender, gestational age, and race.

Results: In control infants, the mean esophageal temperature was 37.2 +/- 0.7 degrees C over the 72-hour period, and 63%, 22%, and 8% of all temperatures were >37 degrees C, >37.5 degrees C, and >38 degrees C, respectively. The mean skin temperature was 36.5 +/- 0.8 degrees C, and 12%, 5%, and 2% of all temperatures were >37 degrees C, >37.5 degrees C, and >38 degrees C, respectively. The odds of death or disability were increased 3.6-4 fold for each 1 degrees C increase in the highest quartile of skin or esophageal temperatures. There were no associations between temperatures and outcomes in the cooling-treated group.

Conclusions: Relatively high temperatures during usual care after hypoxia-ischemia were associated with increased risk of adverse outcomes. The results may reflect underlying brain injury and/or adverse effects of temperature on outcomes.

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Figures

Figure I
Figure I
Esophageal and skin temperatures of both groups are plotted over the 72 hour interval of whole body cooling and subsequent rewarming. Symbols represent the mean and standard deviation. Control infants are represented by black symbols using circles for esophageal and triangles for skin temperature. Whole body cooling infants are represented by gray symbols using inverted triangles for esophageal and squares for skin temperature. Time 0 hours represents the initiation of body cooling in the intervention group.
Figure II
Figure II
The distribution of control infants is plotted among strata of esophageal temperature for the average (avg) of the highest quartile (top panel), median (middle panel), and average of the lowest quartile (lower panel) of temperature. The strata are in 0.5°C increments to facilitate viewing the distribution of the data.
Figure III
Figure III
The distribution of control infants is plotted among strata of skin temperature for the average (avg) of the highest quartile (top panel), median (middle panel), and average of the lowest quartile (lower panel) of temperature. The strata are in 1.0°C increments to facilitate viewing the distribution of the data
See this image and copyright information in PMC

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