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. 2025 Jan 2;184(1):113.
doi: 10.1007/s00431-024-05948-y.

Therapeutic hypothermia in preterm infants under 36 weeks: Case series on outcomes and brain MRI findings

Paola Roca-LLabrés  1 , Melissa Fontalvo-Acosta  2 , Victoria Aldecoa-Bilbao  3 , Ana Alarcón  4
Affiliations

Therapeutic hypothermia in preterm infants under 36 weeks: Case series on outcomes and brain MRI findings

Paola Roca-LLabrés et al. Eur J Pediatr. .

Abstract

Purpose: Perinatal hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal brain injury. Therapeutic hypothermia (TH) is the standard treatment for term neonates, but its safety and efficacy in neonates < 36 weeks gestational age (GA) remains unclear. This case series aimed to evaluate the outcomes of preterm infants with HIE treated with TH.

Methods: Retrospective analysis of preterm infants (< 36w GA) treated with TH (01/2019-06/2024). Data on demographics, clinical complications, coagulation profiles, brain magnetic resonance imaging (MRI), and neurodevelopment outcomes were analyzed.

Results: Seventeen patients were included (range 32.5-35.5w, median 34.4; birthweight range 1556-2493 g, median 2300 g), 58.8% were male. Placental abruption was identified in 7 cases (41.2%), and 8 (47.1%) required advanced resuscitation. Thirteen patients (76.5%) presented anemia, 12 (70.6%) coagulopathy, 9 (52.9%) thrombocytopenia, and 9 (52.9%) acute liver failure. Hypofibrinogenemia (< 1 g/L) was significantly associated with severe intracranial hemorrhage (ICH), defined as extracerebral, intraventricular or parenchymal hemorrhage causing mass effect. MRI findings were classified based on the predominant lesion: I- hypoxic-ischemic injury, II- severe ICH, or III- normal/mild findings. Severe ICH was the predominant lesion in 4 cases (23.5%). White matter injury was seen in 12 (76%). Death occurred in 8 cases (47.1%). Of the 9 surviving patients, at 2 years, 6 (66.7%) had normal neurodevelopment, while 1 (11.1%) had severe disability.

Conclusion: Coagulation abnormalities, particularly hypofibrinogenemia, significantly increase the risk of severe ICH in < 36w infants treated with TH. The safety and efficacy of TH in this population require further investigation.

Keywords: Case Series; Coagulation disorders; Hypoxic-ischemic encephalopathy; Neurodevelopmental Outcomes; Premature Infant; Therapeutic Hypothermia.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval: The study protocol was approved by the Research Ethics Committee of Hospital Clinic Barcelona (approval number HCB/2024/0944) and was conducted following the principles of the Declaration of Helsinki. This committee determined that obtaining informed consent was not required.

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References

    1. Tagin MA, Woolcott CG, Vincer MJ, et al (2012) Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy. Arch Pediatr Adolesc Med 166: https://doi.org/10.1001/archpediatrics.2011.1772
    1. Kattwinkel J, Perlman JM, Aziz K et al (2010) Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 126:e1400–e1413. https://doi.org/10.1542/peds.2010-2972E - DOI - PubMed
    1. Shankaran S, Laptook AR, Ehrenkranz RA et al (2005) Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 353:1574–1584. https://doi.org/10.1056/NEJMCPS050929 - DOI - PubMed
    1. Azzopardi DV, Strohm B, Edwards AD et al (2009) Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 361:1349–1358. https://doi.org/10.1056/NEJMOA0900854 - DOI - PubMed
    1. Simbruner G, Mittal RA, Rohlmann F, et al (2010) Systemic Hypothermia after Neonatal Encephalopathy: Outcomes of neo.nEURO.network RCT. Pediatrics 126:. https://doi.org/10.1542/peds.2009-2441

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