Elsevier

The Journal of Pediatrics

Volume 183, April 2017, Pages 37-42
The Journal of Pediatrics

Original Articles
Safety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy

https://doi.org/10.1016/j.jpeds.2016.11.019Get rights and content

Objective

To evaluate the safety and short-term outcomes of preterm neonates born at 34-35 weeks gestation with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia.

Study design

Medical records of preterm neonates born at 34-35 weeks gestational age with HIE treated with therapeutic hypothermia were retrospectively reviewed. Short-term safety outcomes and the presence, severity (mild, moderate, severe), and patterns of brain injury on magnetic resonance imaging were reviewed using a standard scoring system, and compared with a cohort of term neonates with HIE treated with therapeutic hypothermia.

Results

Thirty-one preterm and 32 term neonates were identified. Therapeutic hypothermia-associated complications were seen in 90% of preterm infants and 81.3% of term infants (P = .30). In the preterm infants, hyperglycemia (58.1% vs31.3%, P = .03) and rewarming before completion of therapeutic hypothermia (19.4% vs 0.0%, P = .009) were more likely compared with term infants. All deaths occurred in the preterm group (12.9% vs 0%, P = .04). Neuroimaging showed the presence of injury in 80.6% of preterm infants and 59.4% of term infants (P = .07), with no differences in injury severity. Injury to the white matter was more prevalent in preterm infants compared with term infants (66.7% vs 25.0%, P = .001).

Conclusions

Therapeutic hypothermia in infants born at 34-35 weeks gestational age appears feasible. Risks of mortality and side effects warrant caution with use of therapeutic hypothermia in preterm infants.

Section snippets

Methods

Our institution participated in the Infant Cooling Evaluation trial15 that included neonates >35 weeks gestational age. After the trial, intramural guidelines were developed for the evaluation of neonates ≥35 weeks gestational age with HIE and subsequent treatment with therapeutic hypothermia. For neonates <35 weeks, individualized risk and benefits were discussed with the family, and consent was obtained before the initiation of therapeutic hypothermia.

Medical records were reviewed

Results

The study cohort included 31 neonates born at 34-35 weeks gestation and 32 term-born neonates with HIE. One preterm neonate treated with therapeutic hypothermia at an outside institution and transferred to our institution was included as complete data for this subject were available.

Maternal clinical and demographic factors in the 2 groups are shown in Table I. Meconium-stained amniotic fluid occurred more often in term infants than preterm infants. Although abruption was more common in preterm

Discussion

In this study of preterm neonates born at 34-35 weeks gestation age with HIE, therapeutic hypothermia was feasible and can be considered as a management strategy for these infants. Although there were no statistical differences in the severity of brain injury on MRI, preterm neonates had an increased incidence of brain injury in the WM and increased mortality secondary to redirection of care related to the severity of encephalopathy.

In randomized trials of therapeutic hypothermia in neonates

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  • Cited by (0)

    Funded by the Thrasher Foundation (to A.M.). The authors declare no conflicts of interest.

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