Therapeutic hypothermia in asphyxiated neonates, using phase change material (Mira Cradle): experience from neonatal intensive care unit of tertiary care centre South India
Abstract
Introduction: Therapeutic hypothermia (TH) is now recommended for the treatment of neonates with Hypoxic-Ischemic Encephalopathy(HIE).This treatment protocol is applied in our department since June 2016. The aim of this study is to report our experience with whole body cooling in asphyxiated neonates admitted in a level 3, Bapuji NICU, Davangere.
Patients and Methods: Prospective study of newborns admitted for HIE from July 2017 to July 2018 that is one year, in Neonatal Intensive Care Unit (NICU) of BCHI, Davangere. The results were reported as short term and long-term neurodevelopment assessment at 1-year age on a newborn group who received hypothermia.
Results: Seventy-two cases of neonates with perinatal asphyxia were admitted in the unit. According to inclusion criteria 50 cases were eligible for the study. The arrival beyond six hours of life was the main cause accounting for not starting therapeutic cooling in birth asphyxia cases. Short come outcome measured in terms of requirement of anticonvulsants, cardiovascular instability, need of mechanical ventilation during stay was significantly reduced with therapeutic cooling. Long term outcome in term of neurodevelopment assessment at 1-year age found significant improvement overall in all domains.
Conclusion: Our first experience with the controlled TH supports its beneficial effect in newborns with HIE. This treatment must be available in all the centers involved in the neonatal care.
Downloads
References
Graham EM, Ruis KA, Hartman AL, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol. 2008;199(6):587-595. doi: 10.1016/j.ajog.2008.06.094.
Lawn JE, Cousens S, Zupan J. 4 Million neonatal deaths: when? where? why? The Lancet. 2005;365(9462):891-900. doi:10.1016/S0140-6736(05).
Robertson CM, Perlman M. Follow-up of the term infant after hypoxic-ischemic encephalopathy. Paediatr Child Health. 2006;11(5):278-282.
Pin TW, Eldridge B, Galea MP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. Europe J Paediat Neurol. 2009;13(3):224-234. doi:10.1016/j.ejpn.2008.05.001.
Jacobs S, Hunt R, Tarnow W. Cooling for newborns with hypoxic ischaemic encephalopathy. Coch Database System Rev. 2013;(1):CD003311. doi:10.1002/14651858.CD003311.pub3.
Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adol Med. 2012;166(6):558-566. doi:10.1001/archpediatrics.2001.1772.
Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696-705. doi:10.1001/archneur. 1976.00500100030012.
Simbruner G, Mittal RA, Rohlmann F. Systemic Hypothermia after Neonatal Encephalopathy: outcomes of neo.nEURO. network RCT. Pediatr. 2010;126(4):e771-e778. doi:10.1542/peds.2009-2441.
Shankaran S, Laptook AR, Ehrenkranz RA. Tyson JE, McDonald SA, et al Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. New Eng J Med. 2005:353(15);1574-1584. doi: 10.1056/NEJMcps050929.
Eicher DJ, Wagner CL, Katikaneni LP. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol. 2005;32(1):11-17. doi: 10.1016/j.pediatrneurol.2004.06.014.
Johnston MV, Trescher WH, Ishida A, Nakajima W. Neurobiology of hypoxic-ischemic injury in the developing brain. Pediatr Res. 2001;49(6):735-741. doi:10.1203/00006450-200106000-00003.
Johnston MV, Fatemi A, Wilson MA Northington F. Treatment advances in neonatal neuroprotection and neurointensive care. Lancet Neurol. 2011;10(4):372-382. doi: 10.1016/S1474-4422(11)70016-3.
Cross JL, Meloni BP, Bakker AJ, Lee S, Knuckey NW. Modes of neuronal calcium entry and homeostasis following cerebral ischemia. Stroke Res Treat. 2010;2010. doi: http://dx.doi.org/10.4061/2010/316862.
Hagberg H, Mallard C, Rousset CI, Wang X. Apoptotic mechanisms in the immature brain: involvement of mitochondria. J Child Neurol. 2009;24(9):1141-1146.
Gunn AJ, Gunn TR, de Haan HH, Williams CE, Gluckman PD. Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest. 1997;99(2):248-256. doi: 10.1172/JCI119153.
Gunn AJ, Bennet L, Gunning MI, Gluckman PD, Gunn TR. Cerebral hypothermia is not neuroprotective when started after postischemic seizures in fetal sheep. Pediatr Res. 1999; 46(3):274-280. doi:10.1203/00006450-199909000-00005.
Gluckman PD, Wyatt J, Azzopardi DV, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicenter randomized trial. Lancet. 2005;365(9460):663-670. doi: https://doi.org/10.1016/S0140-6736(05)17946-X.
Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010; 157(3):367-372. doi: 10.1016/j.jpeds.2010.03.030. Epub 2010 May 20.
Shankaran S, Natarajan G, Chalak L, Pappas A, McDonald SA, Laptook AR. Hypothermia for neonatal hypoxic–ischemic encephalopathy: NICHD Neonatal Research Network contribution to the field. Semin Perinatol. 2016;40(6):385-390. doi: 10.1053/j.semperi.2016.05.009. Epub 2016 Jun 23.
Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxia encephalopathy. N Engl J Med. 2009;361(14):1349-1358. doi: 10.1056/NEJMoa0900854.
McAdams RM, Juul SE. Neonatal encephalopathy: update on therapeutic hypothermia and other novel therapeutics. Clinic Perinatol. 2016;43(3):485-500. doi: 10.1016/j.clp.2016.04.007. Epub 2016 Jun 22.
Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(8):692–700. doi: 10.1001/archpediatrics.2011.43. Epub 2011 Apr 4.
Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012;166(6):558-566. doi: 10.1001/archpediatrics.2011.1772.
Edwards AD, Brocklehurst P, Gunn AJ, Halliday H, Juszczak E, Levene M, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischemic encephalopathy: synthesis and metaanalysis of trial data. BMJ. 2010;340:c363. doi: https://doi.org/10.1136/bmj.c363.
Rutherford M, Ramenghi LA, Edwards AD, Brocklehurst P, Halliday H, Levene M, et al. Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischemic encephalopathy: a nested substudy of a randomized controlled trial. Lancet Neurol. 2010;9(1):39-45. doi: 10.1016/S1474-4422(09)70295-9. Epub 2009 Nov 5.
Shankaran S, Barnes PD, Hintz SR, Laptook AR, Zaterka-Baxter KM, McDonald SA, et al. Brain Injury Following Trial of hypothermia for neonatal hypox-ic-ischaemic encephalopathy. Arch Dis Child. 2012;97(6):F398-F404. doi:10.1136/archdischild-2011–301524.
Dixon G, Badawi N, Kurinczuk JJ, Keogh JM, Silburn SR, Zubrick SR, et al., Early developmental outcomes after newborn encephalopathy. Pediatr. 2002;109(1):26-33. doi: 10.1542/peds.109.1.26.
Mullany LC. Neonatal hypothermia in low-resource settings. Seminars in Perinatol. 2010;34(6):426-433. doi: 10.1053/j.semperi.2010.09.007.
Thoresen M, Tooley J, Liu X, Jary S, Fleming P, Luyt K, et al., Time is brain: starting therapeutic hypothermia within three hours after birth improves motor outcome in asphyxiated newborns. Neonatol. 2013;104(3):228233. doi:10.1159/000353948.
Gunn AJ, Gunn TR, Gunning MI, Williams CE, Gluckman PD. Neuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep. Pediatr. 1998;102(5):1098-1106. doi: https://doi.org/10.1542/peds.102.5.1098
Copyright (c) 2019 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.