Hypothermia for hypoxic–ischemic encephalopathy
- 1 March 2010
- journal article
- Published by Taylor & Francis Ltd in Expert Review of Obstetrics & Gynecology
- Vol. 5 (2), 227-239
- https://doi.org/10.1586/eog.10.7
Abstract
Moderate to severe hypoxic–ischemic injury in newborn infants, manifested as encephalopathy immediately or within hours after birth, is associated with a high risk of either death or a lifetime with disability. In recent multicenter clinical trials, hypothermia initiated within the first 6 postnatal hours has emerged as a therapy that reduces the risk of death or impairment among infants with hypoxic–ischemic encephalopathy. Prior to hypothermia, no therapies directly targeting neonatal encephalopathy secondary to hypoxic–ischemic injury had convincing evidence of efficacy. Hypothermia therapy is now becoming increasingly available at tertiary centers. Despite the deserved enthusiasm for hypothermia, obstetric and neonatology caregivers, as well as society at large, must be reminded that in the clinical trials more than 40% of cooled infants died or survived with impairment. Although hypothermia is an evidence-based therapy, additional discoveries are needed to further improve outcome after HIE. In this article, we briefly present the epidemiology of neonatal encephalopathy due to hypoxic–ischemic injury, describe the rationale for the use of hypothermia therapy for hypoxic–ischemic encephalopathy, and present results of the clinical trials that have demonstrated the efficacy of hypothermia. We also present findings noted during and after these trials that will guide care and direct research for this devastating problem.Keywords
This publication has 87 references indexed in Scilit:
- Outcomes of Safety and Effectiveness in a Multicenter Randomized, Controlled Trial of Whole-Body Hypothermia for Neonatal Hypoxic-Ischemic EncephalopathyPublished by American Academy of Pediatrics (AAP) ,2008
- Elevated Temperature After Hypoxic-Ischemic Encephalopathy: Risk Factor for Adverse OutcomesPediatrics, 2008
- A systematic review of cooling for neuroprotection in neonates with hypoxic ischemic encephalopathy – are we there yet?BMC Pediatrics, 2007
- Hypothermia and perinatal asphyxia: Executive summary of the National Institute of Child Health and Human Development workshopThe Journal of Pediatrics, 2006
- Moderate hypothermia in neonatal encephalopathy: Efficacy outcomesPediatric Neurology, 2005
- Randomized trial of systemic hypothermia selectively protects the cortex on MRI in term hypoxic-ischemic encephalopathyThe Journal of Pediatrics, 2004
- Programmed Cell Death in Animal DevelopmentCell, 1997
- School performance of survivors of neonatal encephalopathy associated with birth asphyxia at termThe Journal of Pediatrics, 1989
- Treatment of the asphyxiated newborn infant: Current opinions and practices as expressed by a panelThe Journal of Pediatrics, 1969
- Hypothermia and the resuscitation of asphyxiated fetal rhesus monkeysThe Journal of Pediatrics, 1966