Elsevier

The Journal of Pediatrics

Volume 145, Issue 6, December 2004, Pages 835-837
The Journal of Pediatrics

Clinical and Laboratory Observation
Randomized trial of systemic hypothermia selectively protects the cortex on MRI in term hypoxic-ischemic encephalopathy

https://doi.org/10.1016/j.jpeds.2004.07.034Get rights and content

Twenty-six infants with hypoxic-ischemic encephalopathy (HIE) were randomized to normothermia or to systemic hypothermia. The hypothermia group had less cortical gray matter signal abnormality on magnetic resonance imaging (MRI) (1/12 vs 7/14 infants in the normothermic group; P = .036), which may indicate differing regional benefit from systemic hypothermia.

Section snippets

Patients and methods

Between July 2001 and June 2003 our study recruited infants at least 35 weeks' gestational age with evidence of intrapartum hypoxia-ischemia comprising at least two of: (a) Apgar score of ≤5 at 10 minutes; (b) ongoing resuscitation in the form of mechanical ventilation at 10 minutes; and (c) metabolic acidosis (cord pH <7.00, or an arterial pH<7.00 or base deficit >12mmol/L or more within the first 60 minutes of life) combined with clinical evidence of encephalopathy. To facilitate recruitment

Results

Twenty-six infants had MRI at similar ages in both infant groups (mean ± SD hypothermia: 5.3 ± 2.9 days; nomothermia 6.3 ± 3.9 days). Only one infant had MRI at <4 days of age (hypothermia group), and one infant died prior to MRI. No infant had an alternative cause for the encephalopathy.

The infants had a mean (SD) gestational age of 38.7 (1.9) weeks and a mean birth weight of 3.55 (0.54) kg. There was no significant difference in gestational age or birth weight between the groups. Each group

Discussion

Our analysis of the MRI findings suggests that hypothermia may preferentially reduce cortical neuronal injury in the term infant with HIE. In contrast, there was no significant alteration in the incidence of basal ganglia abnormalities between the groups. The incidence of deep nuclear gray (DNG) matter injury in approximately 2 of 3 of infants with HIE is consistent with previously published data.6., 7. We are limited by the number of MRI studies to comment on the extent of injury within the

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Supported by the Australian National Health and Medical Research Council (NHMRC Study No: 216725).

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