Hypoxic ischemic encephalopathy and hypothermia: A critical look

Abstract

Hypoxic ischemic encephalopathy is a rare, but serious disease with high rates of death and disability. Cooling therapy (head and whole body) for treatment of hypoxic ischemic encephalopathy appears to be hold promise as a result of 2 trials.1,2 Two additional trials are underway that will double the number of infants tested with various cooling therapies. Longer-term follow-up of infants at school age and beyond is absent at the present time, thus limiting information about long-term safety and efficacy. Additional data (short-term ongoing trial outcomes and long-term follow-up of infants exposed to hypothermia) are likely to provide needed evidence to translate research findings into potential recommendations for practice. It is conceivable that if ongoing studies and follow-up continue to corroborate findings that hypothermia improves the outcome for infants with hypoxic ischemic encephalopathy, obstetricians and neonatologists will be faced with the decision of whether to implement a new therapy for infants who meet specific criteria. Therapeutic hypothermia for perinatal hypoxic ischemic encephalopathy offers a potentially promising therapy for a disease for which there has been no prior treatment, other than supportive measures. Because the current studies have recruited infants within 6 hours of birth, it is very possible that the intervention will require rapid initiation at facilities able to care for infants with hypoxic ischemic encephalopathy who have the potential for improved outcomes. At this point in time, hypothermia for asphyxia should be considered an evolving therapy because of the lack of long-term safety and efficacy data. Once additional outcome (short-term trial and long-term follow-up) data are available, it is likely that the American Academy of Pediatrics and The American College of Obstetricians and Gynecologists would be in a position to issue practice guidelines for patient care, if indicated. © 2005 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.