Therapeutic hypothermia in newborns with ischemic hypoxic encephalopathy

Abstract

Introduction: Hypoxic-ischemic encephalopathy (HIE) is a syndrome of neurological dysfunction secondary to lack of oxygenation of the brain around birth. Therapeutic hyÂpothermia has reduced neonatal mortality and neurological disability. Objectives: To describe the clinical course of neonates with HIE treated with therapeutic hypothermia for 72 hours. Material and methods: In a five-year period, twelve neonates > 34 weeks gestational age, with moderate and severe HIE were treated with therapeutic hypothermia; eight with total body hypothermia and four with selective cranial cooling. Variables recorded were: In-hospital mortality, as well as neurological conditions at hospital discharge, both clinical and those obtained from magnetic resonance imaging (MRI) and neurophysiological studies. Results: The twelve neonates started therapeutic hypothermia before six hours of life, maintaining it for 72 hours. Two patients died after hypothermia. Eight patients were discharged without evidence of neurological impairment. MRI was normal in five patients; three had cerebral edema and two patients had cerebral infarcts. Auditory, visual and somatosensory potentials were normal in five patients; while the rest had alterations in the auditory pathway. Conclusions: Therapeutic hypothermia by total body hypothermia or head cooling in infants with moderate and severe EHI appear to be effective in limiting neurological damage.