Am J Perinatol 2020; 37(09): 955-961
DOI: 10.1055/s-0039-1692388
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcome and Feasibility after 7 Years of Therapeutic Hypothermia in Southern Brazil

Renato S. Procianoy
1   Newborn Section, Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
,
Andrea L. Corso
1   Newborn Section, Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
,
Bruna O. Schoenardie
1   Newborn Section, Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
,
Georgia P.F. de Oliveira
1   Newborn Section, Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
,
Maria G. Longo
1   Newborn Section, Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
,
Rita C. Silveira
1   Newborn Section, Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
› Author Affiliations
Further Information

Publication History

03 November 2018

26 April 2019

Publication Date:
06 June 2019 (online)

Abstract

Objective This study aimed to describe the experience with a protocol of therapeutic hypothermia (TH) in southern Brazil.

Study Design Newborns with gestational age > 35 weeks with evidence of perinatal asphyxia plus moderate or severe encephalopathy were recruited between March 2011 and November 2017. Whole-body hypothermia for 72 hours, starting within the first 6 hours of life was used. Survivors underwent magnetic resonance imaging (MRI) and electroencephalogram (EEG). The primary outcome was death during hospitalization and neurodevelopment assessed using the Bayley Scales of Infant Development III (BSID III) at 12 months of age.

Results A total of 72 newborns were treated (41 with moderate encephalopathy and 31 with severe encephalopathy), of whom 16 died. MRI was performed in 56 patients, and 24 presented some alterations. Fifty-three patients had an EEG: 11 normal, 20 mildly altered, 12 moderately altered, and 10 severely altered. Forty patients were evaluated through BSID III: 45% presented with some delay in neurodevelopment, 8 (20%) had motor retardation, 15 (37.5%) had language delay, and 13 (32.5%) had a delay in cognitive development.

Conclusion Mortality and adverse events were similar to those described in large randomized controlled trials. TH is a safe and an effective method of neurologic protection in asphyxiated newborns in a developing country when performed adequately.

 
  • References

  • 1 Lee AC, Kozuki N, Blencowe H. , et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res 2013; 74 (01) (Suppl. 01) 50-72
  • 2 Pauliah SS, Shankaran S, Wade A, Cady EB, Thayyil S. Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis. PLoS One 2013; 8 (03) e58834
  • 3 Papile LA, Baley JE, Benitz W. , et al; Committee on Fetus and Newborn. Hypothermia and neonatal encephalopathy. Pediatrics 2014; 133 (06) 1146-1150
  • 4 Shankaran S, Laptook AR, Ehrenkranz RA. , et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
  • 5 Azzopardi DV, Strohm B, Edwards AD. , et al; TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361 (14) 1349-1358
  • 6 Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Coch Dat System Rev 2013; (01) CD003311
  • 7 Azzopardi D, Strohm B, Marlow N. , et al; TOBY Study Group. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med 2014; 371 (02) 140-149
  • 8 Edwards AD, Brocklehurst P, Gunn AJ. , et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ 2010; 340: c363
  • 9 Eicher DJ, Wagner CL, Katikaneni LP. , et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32 (01) 11-17
  • 10 Gluckman PD, Wyatt JS, Azzopardi D. , et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 (9460): 663-670
  • 11 Shankaran S, Pappas A, McDonald SA. , et al; Eunice Kennedy Shriver NICHD Neonatal Research Network. Childhood outcomes after hypothermia for neonatal encephalopathy. N Engl J Med 2012; 366 (22) 2085-2092
  • 12 Jacobs SE, Morley CJ, Inder TE. , et al; Infant Cooling Evaluation Collaboration. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165 (08) 692-700
  • 13 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10) 696-705
  • 14 Zanelli SA, Naylor M, Dobbins N. , et al. Implementation of a ‘Hypothermia for HIE’ program: 2-year experience in a single NICU. J Perinatol 2008; 28 (03) 171-175
  • 15 Rutherford M, Ramenghi LA, Edwards AD. , 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; 9 (01) 39-45
  • 16 Liauw L, Palm-Meinders IH, van der Grond J. , et al. Differentiating normal myelination from hypoxic-ischemic encephalopathy on T1-weighted MR Images: a new approach. Am J Neuroradiol 2007; 28 (04) 660-665
  • 17 Bayley N. Bayley Scales of Infant and Toddler Development—Third Edition: Technical Manual. San Antonio, TX: Harcourt Assessment; 2006
  • 18 Fleiss B, Tann CJ, Degos V. , et al. Inflammation-induced sensitization of the brain in term infants. Dev Med Child Neurol 2015; 57 (03) (Suppl. 03) 17-28
  • 19 Falck M, Osredkar D, Wood TR. , et al. Neonatal systemic inflammation induces inflammatory reactions and brain apoptosis in a pathogen-specific manner. Neonatology 2018; 113 (03) 212-220
  • 20 Robertson NJ, Nakakeeto M, Hagmann C. , et al. Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial. Lancet 2008; 372 (9641): 801-803
  • 21 Eicher DJ, Wagner CL, Katikaneni LP. , et al. Moderate hypothermia in neonatal encephalopathy: safety outcomes. Pediatr Neurol 2005; 32 (01) 18-24
  • 22 Procianoy RS, Corso AL, Longo MG, Vedolin L, Silveira RC. Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: magnetic resonance imaging findings and neurological outcomes in a Brazilian cohort. J Matern Fetal Neonatal Med 2019; 32 (16) 2727-2734