Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: Current Experience of a Turkish Tertiary Center

Öz

Objective: We conducted a study to demonstrate the effect of early initiation of cooling in newborns with Hypoxic-ischemic encephalopathy HIE , before and during their transport to a cooling center.Study Design: A total of 32 outpatient neonates were enrolled in the study. Because of the implementation of a new local guideline concerning the preparation and transport of neonates who are therapeutic hypothermia TH candidates, the data gathered belonged to two distinct patient groups; Group I before guideline, n=18 and Group II after guideline , n=14 .Results: With respect to clinical characteristics, application of TH and conservative therapies both groups were similar. The frequency of observed clinical seizures, the occurence of an abnormal aEEG and the mean body temperature of the outborn infants at their admission were all lower in Group II. With respect to mortality, the mortalities of Group I and Group II were 44.4% and 21.4% respectively and except hypotension, all complications were less frequent in Group II. An organized team approach with early cooling is important for the success of TH.Conclusion: We found that with education, our referring and transport physicians can initiate and maintain TH for neonates before and during their transport.

Anahtar Kelimeler

• Hypothermia,hypoxia-ischemia,brain / therapy,newborn,patient transport

Yenidoğanda Hipoksik İskemik Ensefalopati Tedavisinde Hipotermi Uygulaması: Tek Merkez Deneyimi

Öz

Amaç: Çalışmanın amacı hipotermi uygulama merkezine transport edilmeden önce ve transport sırasında erken soğutma başlamasının etkilerini araştırmaktır.Metod: Değerlendirmeye 32 yenidoğan bebek alındı. Tedavi amaçlı hipotermi uygulamasına aday yenidoğan bebeklerin transportu ve kazırlanmasında yeni bölgesel rehberin etkilerini araştırmak için bu rehberin kullanılmasından önce n=18 ve sonra n=14 kabul edilen yenidoğan bebekler çalışmaya dahil edildi.Sonuçlar: Her iki grupta da sırasıyla klinik özellikler hipotermi uygulaması ve diğer tedaviler benzerdi. Lokal rehberin kullanıma girmesinden sonra hastanemize dış merkezlerden kabul edilen bebeklerde grup II klinik nöbet, anormal aEEG bulgusu ve geliş ortalam vücut sıcaklığında artış saptandı. Mortalite oranları Grup I’de %44.4 ve Grup II’de %21.4 olarak hesaplandı. Hipotansiyon dışında tüm komplikasyonların sıklığı Grup II’de daha az bulunndu. Başarılı tedavi amaçlı hipotermi için organize ekip yaklaşımı önemlidir.Tartışma: Sevk eden ve transfer eden ekiplerin eğitimi ile yenidoğanların transport öncesi ve sırasında hipotermi başlanabilir ve sürdürülebilir.

Anahtar Kelimeler

• Hipotermi,hipoksi-iskemi beyin / tedavi,yenidoğan,hasta nakli

Kaynakça

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