Evaluation of whole body hypothermia on term neonates with hypoxic ischemic encepholopathy

Abstract

Aim: To investigate the effect of whole body hypothermia on short term neonatal morbidities and long term neurodevelopmental outcome in term neonates with hypoxic ischemic encephalopathy Material and Method: Neonates with perinatal asphyxia and hypoxic ischemic encepholopathy stage 2 and 3 were enrolled Patients were divided into 2 groups according to findings observed on amplitude integrated electroencephalography aEEG Patients with abnormal aEEG pattern in the first six hours after birth were defined as group 1 and others as group 2 Patients in group 1 were treated with whole body hypothermia Neurodevelopmental outcome was evaluated at 18 months of age in survivors using Bayley Scales of Infant Development II Mental developmental index and psychomotor development index scores were calculated Results: Thirty five patients were enrolled M F=17 18 18 51 of whom were treated with hypothermia Bradycardia was observed in 44 4 of patients in group 1 and 5 9 of patients in group 2 p=0 04 Incidence of other possible adverse events related to hypothermia were similar between the two groups Mortality was higher in group 1 p=0 03 In group 1 70 of the patients and in group 2 86 of the patients were evaluated using Bayley Scales of Infant Development II Although patients treated with hypothermia had a higher mental developmental index and psychomotor development index scores the difference was not statistically significant Conclusions: Whole body hypothermia can be safely applied in term neonates with HIE Hypothermia may improve neurodevelopmental outcome Turk Arch Ped 2011; 46: 286 91

Keywords

• -

Tüm vücut soğutma yöntemi ile hipotermi uygulanan hipoksik iskemik ansefalopatili yenidoğanların değerlendirilmesi

Öz

Amaç: Bu çalışmada hipoksik iskemik ansefalopatili zamanında doğmuş yenidoğanlara tüm vücut soğutma yöntemi ile uygulanan hipotermi tedavisinin hem doğum sonrası erken sorunlara hem de uzun dönem nörogelişimsel sonuçlara olan etkisinin değerlendirilmesi amaçlandı.

Gereç ve Yöntem: Çalışmaya perinatal asfiksi ve hipoksik iskemik ansefalopati evre 2 3 tanılı yenidoğan bebekler alındı Olgular ilk altı saatteki amplitüt entegre elektroansefalogram aEEG bulgularına göre iki gruba ayrıldı; Grup 1: aEEG bulguları anormal olan veya klinik nöbet gözlenen ve hipotermi tedavisi uygulananlar Grup 2: aEEG bulguları normal olan ve hipotermi tedavisi uygulanmayanlar Yaşayan olguların 18 ayda Bayley Gelişim Ölçeği 2 kullanılarak mental gelişim indeksi ve psikomotor gelişim indeksi puanları hesaplandı Çalışma için yerel etik kuruldan onay alındı Onay no:8

Bulgular: Toplam 35 hasta Kız=18 Erkek=17 çalışmaya alındı On sekiz olguya 51 hipotermi tedavisi uygulandı Grup 1 rsquo;deki olguların 44 4 rsquo;ünde grup 2 rsquo;deki olguların ise 5 9 rsquo;unda bradikardi saptandı p=0 04 Diğer klinik bozuklukların görülme sıklığı bakımından gruplar arasında önemli bir fark yoktu Grup 1 rsquo;deki olguların ölüm oranı grup 2 rsquo;den yüksekti p=0 03 Grup 1 rsquo;deki olguların 70 rsquo;i; grup 2 rsquo;deki olguların ise 86 rsquo;sı nörogelişimsel açıdan değerlendirilebildi Hipotermi uygulanan olguların nörogelişimsel değerlendirme sonuçları diğer gruba göre daha iyi olmakla birlikte aradaki fark istatistiksel olarak anlamlı değildi

Çıkarımlar: Hipotermi tedavisi hipoksik iskemik ansefalopatili olgularda uygulanabilir Hipotermi uzun dönemde nörogelişimsel sonuçların daha iyi olmasına katkı sağlayabilir,

Anahtar Kelimeler

• Hipoksik iskemik ansefalopati
• hipotermi
• perinatal asfiksi
• yenidoğan

Kaynakça

1. Perlman JM. Intervention strategies for neonatal hypoxic-ischemic cerebral injury. Clin Ther 2006; 28: 1353-65.
2. Palmer C. Vanucci RC. Potential new therapies for perinatal cerebral hypoxia-ischemia. Clin Perinatol 1993; 20: 411-32.
3. Blackmon LR, Stark AR; American Academy of Pediatrics Committee on Fetus and Newborn. Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopaty. Pediatrics 2006; 117: 942-8.
4. Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Use and abuse of the Apgar score. Pediatrics 1996; 98: 141-2.
5. Sarnat HB, Sarnat MS. Neonatal encephalopaty following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33: 696-705.
6. Bayley N. Bayley scales of infant development II. San Antonio, TX: Psychological Corporation; 1993.
7. Sarkar S, Barks JD. Systemic complications and hypothermia. Semin Fetal Neonatal Med 2010; 15: 270-5.
8. Wyatt JS, Gluckman PD, Liu PY, et al. Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics 2007; 119: 912-21.

9. Vanucci RC. Hypoxic-ischemic encephalopathy. Am J Perinatol 2000; 17: 113-20.
10. Ter Horst HJ, Sommer C, Bergman KA, Fock JM, van Weerden TW, Bos AF. Prognostic significance of amplitude-integrated EEG during the first 72 hours after birth in severely asphyxiated neonates. Pediatr Res 2004; 55: 1026-33.
11. Hellström-Westas L, Rosèn I. Continuous brain-function monitoring: state of the art in clinical practice. Semin Fetal Neonatal Med 2006; 11: 503-11.
12. Spitzmiller RE, Phillps T, Meinzen Derr J, Hoath SB. Amplitude- integrated EEG is useful in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy: a meta-analysis. J Child Neurol 2007; 22: 1069-78.
13. Volpe JJ. Hypoxic-ischemic encephalopathy: clinical aspects. In: Volpe JJ (ed). Neurology of the newborn. Philadelphia: WB Saunders, 2001: 331-94.
14. Van Bel F, Groenendaal F. Long-term pharmacologic neuroprotection after birth asphyxia: Where do we stand? Neonatology 2008; 94: 203-10.
15. Laptook AR, Corbert RJ. Therapeutic hypothermia: a potential neuroprotective and resuscitative strategy for neonatal hypoxia- iskemia. Prenat Neonat Med 1996; 1: 199-212.
16. Sahni R, Sanocka UM. Hypothermia for hypoxic-ischemic encephalopaty. Clin Perinatol 2008; 35: 717-34.
17. Gluckman PD, Wyatt JS, Azzopardi D, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365: 663-70.
18. Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 15: 1574-84.
19. Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopaty. N Engl N Engl J Med 2010; 362: 1056.
20. Johnston MV, Fatemi A, Wilson MA, Northington F. Treatment advances in neonatal neuroprotection and neurointensive care. Lancet Neurol 2011; 10: 372-82.