Hello friends 👋
This week we are talking about therapeutic hypothermia for neonatal encephalopathy. As usual, we started by reviewing the history of this intervention which dates back further than you might imagine. We reviewed the major trials assessing the effects of hypothermia on HIE and Daphna walked us through the pathophysiology of HIE and how cooling can reduce the degree of brain injury. We had the pleasure and the honor to welcome Dr. Michael Weiss who answered a few burning questions on the topic of cooling (pun intended). We reviewed a few studies that looked at alternative use of hypothermia and concluded our week as we usually do with an episode focused on board review questions.
We wanted to thank you again for your continued support.
Please find resources below👇
Follow this link to access this week's powerpoint presentation:
Here are some interesting neoreviews articles that summarize a lot of important concepts regarding therapeutic hypothermia:
Caveats of Cooling: Available Evidence and Ongoing Investigations of Therapeutic Hypothermia - PubMed
Therapeutic hypothermia (TH) mitigates the long-term effects of neuronal excitotoxicity and cell death seen in hypoxic-ischemic encephalopathy (HIE). It remains the most evidence-based therapy for HIE, but it is not without clinical controversy. The literature abounds with questions, such as “When s…
Joanna Parga-Belinkie
Here are a list of the articles mentioned on the show this week in order of "appearance"
Hypothermia treatment and the newborn - PubMed
Hypothermia treatment and the newborn
J S WyattFactors in Neonatal Resistance to Anoxia. I. Temperature and Survival of Newborn Guinea Pigs Under Anoxia - PubMed
Factors in Neonatal Resistance to Anoxia. I. Temperature and Survival of Newborn Guinea Pigs Under Anoxia
J A MillerHYPOTHERMIA IN THE TREATMENT OF ASPHYXIA NEONATORUM - PubMed
HYPOTHERMIA IN THE TREATMENT OF ASPHYXIA NEONATORUM
J A MILLER JrSchool performance of survivors of neonatal encephalopathy associated with birth asphyxia at term - PubMed
School performance testing was completed at 8 years of age on 145 children who had had neonatal encephalopathy associated with birth asphyxia as term infants and on a comparison peer group of 155 children. The prospectively identified clinical categories of encephalopathy for the neonates were 56 mi…
C M RobertsonAcute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants - PubMed
Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hemat…
S ShankaranModerate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia - PubMed
Intra-ischemic moderate hypothermia generally protects the brain against ischemic cell death, while hypothermia instigated several hours into the reperfusion phase is considered to be less effective. Here we report the effect of hypothermia (32.5 degrees - 33.5 degrees C) of 5-h duration, initiated…
C CoimbraKeeping a cool head, post-hypoxic hypothermia--an old idea revisited - PubMed
Hypoxia-ischaemia produces permanent brain damage by processes that continue for many hours after reoxygenation/reperfusion. This provides a window of opportunity for therapy aimed at preventing further loss of brain cells. Reducing brain temperature by 2-6 degrees C for 3-72 h after reoxygenation/r…
M ThoresenNeuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep - PubMed
Delayed selective head cooling begun before the onset of postischemic seizures and continued for 3 days may have potential to significantly improve the outcome of moderate to severe hypoxic-ischemic encephalopathy.
A J GunnWhole-body hypothermia for neonatal encephalopathy: animal observations as a basis for a randomized, controlled pilot study in term infants - PubMed
Animal studies showed that a simple modification of a commercially available cooling system (2 blankets attached, subject lying on 1 and the second hanging freely) results in stable core body and brain temperature when used in the automatic control mode. The pilot study in term infants with encephal…
Seetha ShankaranWhole-body hypothermia for neonates with hypoxic-ischemic encephalopathy - PubMed
Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy.
Seetha ShankaranSelective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial - PubMed
These data suggest that although induced head cooling is not protective in a mixed population of infants with neonatal encephalopathy, it could safely improve survival without severe neurodevelopmental disability in infants with less severe aEEG changes.
Peter D GluckmanModerate hypothermia to treat perinatal asphyxial encephalopathy - PubMed
Induction of moderate hypothermia for 72 hours in infants who had perinatal asphyxia did not significantly reduce the combined rate of death or severe disability but resulted in improved neurologic outcomes in survivors. (Current Controlled Trials number, ISRCTN89547571.)
Denis V AzzopardiHypothermia: a systematic review and meta-analysis of clinical trials - PubMed
Hypothermia is a potential neuroprotective intervention to treat neonatal post-asphyxial (hypoxic-ischemic) encephalopathy (HIE). In this meta-analysis of 13 clinical trials published to date, therapeutic hypothermia was associated with a highly reproducible reduction in the risk of the combined out…
Prakesh S ShahCooling neonates who do not fulfil the standard cooling criteria - short- and long-term outcomes - PubMed
Cooling can be considered for infants with neonatal encephalopathy following postnatal collapse or preterm birth, those with underlying surgical or cardiac conditions, and infants starting cooling >6 postnatal hours.
Elisa SmitEffect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial - PubMed
clinicaltrials.gov Identifier: NCT01192776.
Seetha ShankaranEffect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial - PubMed
clinicaltrials.gov Identifier: NCT01192776.
Seetha ShankaranEffect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial - PubMed
clinicaltrials.gov Identifier: NCT01192776.
Seetha ShankaranEffect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial - PubMed
clinicaltrials.gov Identifier: NCT00614744.
Abbot R LaptookCooling infants with mild hypoxic ischaemic encephalopathy- Do we have the evidence? - PubMed
Cooling infants with mild hypoxic ischaemic encephalopathy- Do we have the evidence?
Ashok BuchiboyinaTherapeutic hypothermia for mild neonatal encephalopathy: a systematic review and meta-analysis - PubMed
Current evidence is insufficient to recommend routine therapeutic hypothermia for babies with mild encephalopathy and significant benefits or harm cannot be excluded.
Ujwal KariholuIs there a role for therapeutic hypothermia administration in term infants with mild neonatal encephalopathy? - PubMed
Outcomes were favorable with mild NE whereas four infants with moderate NE developed CP. A potential role for TH in this population requires further study.
Laura PerrettaTherapeutic hypothermia initiated within 6 hours of birth is associated with reduced brain injury on MR biomarkers in mild hypoxic-ischaemic encephalopathy: a non-randomised cohort study - PubMed
Therapeutic hypothermia may have a neuroprotective effect in babies with mild HIE, as demonstrated by improved MRS biomarkers and reduced white matter injury on MRI. This may warrant further evaluation in adequately powered randomised controlled trials.
Paolo MontaldoInitiation of passive cooling at referring centre is most predictive of achieving early therapeutic hypothermia in asphyxiated newborns - PubMed
Initiating passive cooling at the referring centre, before transfer, is critical to faster achievement of target core temperature in asphyxiated infants. Greater outreach education and development of clinical care pathways are needed to improve optimal delivery of TH to enhance outcome.
Brigitte Lemyre