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. 2021 Mar;110(3):805-810.
doi: 10.1111/apa.15506. Epub 2020 Aug 12.

Necessity of early and continuous monitoring for possible infectious complications in children undergoing therapeutic hypothermia

Jennifer B Brandt  1 , Sabine Steiner  2 , Gerald Schlager  1 , Kambis Sadeghi  1 , Regina Vargha  1 , Johann Golej  1 , Michael Hermon  1
Affiliations

Necessity of early and continuous monitoring for possible infectious complications in children undergoing therapeutic hypothermia

Jennifer B Brandt et al. Acta Paediatr. 2021 Mar.

Abstract

Aim: Since therapeutic hypothermia (TH) is known for its inhibitory effects on leucocyte migration and cytokine synthesis, our aim was to underline the necessity of early monitoring for potential immunomodulatory risks.

Methods: Using a 13-year retrospective case-control study at the paediatric intensive care unit (PICU) of the Medical University in Vienna, all newborn infants and children receiving TH were screened and compared with a diagnosis-matched control group undergoing conventional normothermic treatment (NT). TH was accomplished by using a non-invasive cooling device. Target temperature was 32-34°C. Children with evident infections, a medical history of an immunodeficiency or undergoing immunosuppressive therapy, were excluded.

Results: During the observational period, 108 patients were screened, 27 of which underwent TH. Culture-proven infections occurred in 22% of the TH group compared with 4% of the normothermic controls (P = .1). From the second day following PICU admission, median C-reactive protein (CRP) values were higher in the TH group (day two P = .002, day three P = .0002, day six P = .008).

Conclusion: Children undergoing TH showed earlier and higher increases in CRP levels when compared to normothermic controls. These data underline the necessity of early and continuous monitoring for possible infectious complications.

Keywords: C-reactive protein; continuous monitoring; infectious complications; non-invasive cooling; therapeutic hypothermia.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Primary diagnoses. Data are presented as percentages unless otherwise indicated
Figure 2
Figure 2
Progression of CRP. Data are presented as median [interquartile range, IQR] unless otherwise indicated. 0, day of admission; 1‐6, day one to six; **P < .01; ***P < .001
Figure 3
Figure 3
Kaplan‐Meier estimator of survival. Data are presented as percentages unless otherwise indicated
See this image and copyright information in PMC

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