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Magnetic resonance biomarkers of hypothermic rescue neuroprotection following neonatal encephalopathy in a south indian neonatal unit
  1. S Thayyil1,
  2. F Cowan2,
  3. D Price1,
  4. E Cady1,
  5. M Ayer3,
  6. N Marlow1,
  7. S Shankaran4,
  8. N Robertson1,
  9. B Guhan3
  1. 1University College London, London, UK
  2. 2Imperial College London, London, UK
  3. 3Calicut Medical College, Kerala, India
  4. 4Wayne State University, Detroit, Michigan, USA

Abstract

Efficacy of therapeutic hypothermia (TH) in encephalopathic infants with co-existent sepsis is unknown; we assessed the brain tissue injury using magnetic resonance (MR) biomarkers in a south Indian public sector neonatal unit.

Methods We randomly allocated 33 infants (≥36 weeks, ≥1800 g) with neonatal encephalopathy (NE) to TH (reduction of rectal temperature to 33.5°C for 72 h) or standard care within 6 h of birth. MR images were acquired between day 7 and 11 using a 1.5 Tesla Siemens Avanto MR scanner and scored by a single reader using a previously validated proforma.1

Results Baseline characteristics were similar in the cooled (n=17) and standard care (n=16) groups; six infants died before MR imaging.

A trend towards increased sepsis (19% vs 53%), higher background EEG abnormality on day 4 (29% vs 47%) was seen in cooled infants. The brain tissue injury scores in the basal ganglia (odds ratio (95%CI) 3.4 (0.5, 22)), white matter (WM) (0.5 (0.08, 2.6) and cortex (4.7 (0.7,30) were similar in the control and cooled infants. No difference was seen on tract based spatial statistics with cooling; fractional anisotropy values were similar over the anterior and posterior limbs of internal capsule.

Conclusions TH did not reduce the brain injury after NE in this population; this may be due to different population co-morbidities and/or higher incidence of perinatal sepsis than in high-income settings. Carefully controlled clinical trials are required before TH is routinely used in these settings.

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