Therapeutic hypothermia in neonatal asphyxia

Abstract

Hypoxic ischemic encephalopathy is a serious condition affecting newborn infants which can result in death and disability. There is now strong clinical evidence that moderate post-asphyxial total body cooling or hypothermia in full term neonates results in long-term neuroprotection, allowing us to proclaim this innovative therapy as "standard of care." The treatment is a time-critical emergency and should be started within 6 hours after the insult. Such -requires optimal collaboration among local hospitals, transport teams and the closest neonatal intensive care unit. The technique is only safe when applied according to published clinical trial protocols, and with admission of these patients to a neonatal intensive care unit. Future studies should be aimed at optimizing the onset, duration, and depth of hypothermia. Combination of hypothermia and drugs may further improve neuroprotection in asphyxiated full term neonates.

Keywords: HIE; Newborn; aEEG; asphyxia; hypothermia.

Fig. 1. Three phases during an asphyxiating insult in the term newborn infant. In neonatal animals, secondary energy failure occurs between 24 to 48 hours after hypoxia-ischemia.

Fig. 2. Clinical setting of hypothermia. Total body cooling using the Criticool device.