Document Detail

Therapeutic hypothermia for hypoxic-ischaemic encephalopathy in the newborn infant.
MedLine Citation:
PMID:  15791139     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: This review examines recent findings from experimental models and clinical trials of induced hypothermia as treatment after cerebral hypoxia-ischaemia in term newborn infants.
RECENT FINDINGS: Experimental hypothermia inhibits many steps in the biochemical cascade that produces severe brain injury after hypoxia-ischaemia. This is in contrast to pharmacological agents, which tend to target only one step in the process that leads to brain injury. In adult humans hypothermia initiated immediately after cardiac arrest has improved outcomes. Delayed cooling after brain trauma has also been effective in a subgroup of adult patients. Seventy-two hours of selective head cooling with mild systemic hypothermia (rectal temperature 34.5 degrees C) in term infants with hypoxic-ischaemic encephalopathy (HIE) reduced death or disability in the infants with less severe electroencephalographic changes at entry (no benefit in those with advanced electroencephalographic changes). Cooling had no apparent adverse effects. A smaller randomized clinical trial of 48 h whole body cooling (rectal T 33 degrees C) found a reduction in death and neurological impairment.
SUMMARY: In term infants with HIE there is emerging evidence that both selective head cooling and whole body cooling are neuroprotective and safe. This is consistent with a wealth of experimental animal data and adult trials. Neuroprotection seems to be lost if cooling is started after 6 h. The challenge now is to complete ongoing trials. If meta-analysis confirms a therapeutic effect, then this may lead to selection criteria and treatment protocols for very early hypothermia in HIE at term.
Marianne Thoresen; Andrew Whitelaw
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in neurology     Volume:  18     ISSN:  1350-7540     ISO Abbreviation:  Curr. Opin. Neurol.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-25     Completed Date:  2005-06-13     Revised Date:  2013-01-18    
Medline Journal Info:
Nlm Unique ID:  9319162     Medline TA:  Curr Opin Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  111-6     Citation Subset:  IM    
Department of Clinical Science, University of Bristol, Bristol, UK.
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MeSH Terms
Asphyxia Neonatorum / therapy*
Hypothermia, Induced / methods*
Hypoxia-Ischemia, Brain / therapy*
Infant, Newborn

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