Original ArticlesSafety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy
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
References (29)
- et al.
Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial
Lancet
(2005) - et al.
Perinatal acidosis and hypoxic-ischemic encephalopathy in preterm infants of 33 to 35 weeks' gestation
J Pediatr
(2012) - et al.
Severe fetal acidemia and subsequent neonatal encephalopathy in the larger premature infant
Pediatr Neurol
(2005) - et al.
Hypothermia therapy for neonatal hypoxic ischemic encephalopathy in the state of California
J Pediatr
(2014) - et al.
Origin and timing of brain lesions in term infants with neonatal encephalopathy
Lancet
(2003) - et al.
Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic- ischaemic encephalopathy: a nested substudy of a randomised controlled trial
Lancet Neurol
(2010) - et al.
Nucleated red blood cell counts: an early predictor of brain injury and 2-year outcome in neonates with hypoxic-ischemic encephalopathy in the era of cooling-based treatment
Brain Dev
(2014) - et al.
Cooling for newborns with hypoxic ischaemic encephalopathy
Cochrane Database Syst Rev
(2013) - et al.
Childhood outcomes after hypothermia for neonatal encephalopathy
N Engl J Med
(2012) - et al.
Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy
N Engl J Med
(2005)
Moderate hypothermia to treat perinatal asphyxial encephalopathy
N Engl J Med
Therapeutic hypothermia in the prevention of hypoxic-ischaemic encephalopathy: new categories to be enrolled
J Matern Fetal Neonatal Med
The effect of cerebral hypothermia on white and grey matter injury induced by severe hypoxia in preterm fetal sheep
J Physiol
Mild controlled hypothermia in preterm neonates with advanced necrotizing enterocolitis
Pediatrics
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Funded by the Thrasher Foundation (to A.M.). The authors declare no conflicts of interest.