Therapeutic hypothermia in asphyxiated neonates with hypoxic-ischemic encephalopathy: A single-center experience from its first application in Greece

Abstract

Background/aim: Therapeutic hypothermia has become an established therapy in asphyxiated neonates with evidence of moderate/severe hypoxic-ischemic encephalopathy. Herein, we describe our recent experience with total body cooling in asphyxiated neonates, which is the first relevant report in Greece.

Patients and methods: The medical records of all asphyxiated newborns treated with therapeutic hypothermia in our center between September 2010 and October 2013 were retrospectively reviewed. We recorded data related to neonatal-perinatal characteristics, whole body cooling and outcome.

Results: Twelve asphyxiated neonates [median gestational age 38 weeks (36-40)] received whole body cooling (rectal temperature 33.5 ± 0.5 (o)C for 72 hours) during the study period for moderate (n=3) and severe (n=9) hypoxic-ischemic encephalopathy. Cooling was passive in 4 and active in 8 (66.7%) cases. Therapeutic hypothermia was initiated at the median age of 5 hours (0.5-11) after birth. Seven neonates survived (58.3%) to hospital discharge. On follow-up (7-35 months), neurodevelopment outcome was normal in 1 case, while 3, 1 and 2 subjects had mild, moderate and severe impairment, respectively.

Conclusions: Our initial experience with whole body cooling supports its beneficial effect in asphyxiated neonates. This treatment should be offered in all centers involved in the care of such neonates using either simple means (passive cooling) or automated cooling devices. Hippokratia 2014; 18 (3): 226-230.

Keywords: neonatal care; neonatal encephalopathy; perinatal asphyxia.

Figure 1. Frequency (%) of the neonatal complications observed during cooling. Bradyc: Bradycardia, PPHN: Persistent pulmonary hypertension of the neonate, Hypoten./Inotr.: Inotropes for arterial hypotension, Thro/penia: Thrombocytopenia, DIC: Disseminated intravascular coagulation, AKI: Acute kidney injury, Ins. Inf.: Insulin infusion for hyperglycemia, Liv. Dys. Liver dysfunction, EOS: Early-onset sepsis.