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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.

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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