This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Battin, M. R.
Right arrow Articles by Gunn, A. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Battin, M. R.
Right arrow Articles by Gunn, A. J.
Related Collections
Right arrow Premature & Newborn

PEDIATRICS Vol. 107 No. 3 March 2001, pp. 480-484

Neurodevelopmental Outcome of Infants Treated With Head Cooling and Mild Hypothermia After Perinatal Asphyxia

Received Aug 14, 2000; accepted Oct 3, 2000.

Malcolm R. Battin*, Dagger , J. Anne Dezoete*, Tania R. Gunn*, Dagger , §, Peter D. Gluckman§, and Alistair J. GunnDagger , §

From the * Newborn Service, National Women's Hospital, Auckland, New Zealand; and the Dagger  Department of Paediatrics and § Research Centre for Developmental Medicine and Biology, University of Auckland, Auckland, New Zealand.

Objectives.  To determine the neurodevelopmental outcome of infants treated with head cooling with systemic hypothermia after hypoxic-ischemic encephalopathy.

Study Group.  Infants >= 37 weeks' gestation, who had an umbilical artery pH <= 7.09 or Apgar score <= 6 at 5 minutes, plus clinical encephalopathy. Infants with major congenital abnormalities were excluded.

Trial Design.  Infants were allocated to either no cooling (rectal temperature = 37.0 ± 0.2°C, n = 15), or, sequentially, to head cooling accompanied by different levels of systemic hypothermia, including minimal cooling, rectal temperature 36.5°C to 36°C (n = 6), and mild cooling, to either 35.9°C to 35.5°C (n = 6), 35 ± 0.5°C (n = 6) or 34.5 ± 0.5°C (n = 7). Head cooling was accomplished by circulating cooled water through a coil of tubing wrapped around the head for up to 72 hours. Survivors were followed up with regular neurologic examination by a neonatologist until 18 months of age, then with blinded developmental testing using the revised Bayley Scales.

Results.  A total of 40 term infants were enrolled from 2 to 5 hours after birth. The control and the cooled groups were not significantly different for gestation, birth weight, Apgar score, and initial pH. There were 6 early neonatal deaths (3 normothermic and 3 cooled), and 1 death in infancy associated with severe spastic cerebral palsy in a normothermic infant. Six normothermic, 1 minimally cooled, and 4 mildly cooled infants had early stage 1 encephalopathy; all but 1 had a good outcome. Among infants with early stage 2 or 3 encephalopathy, an adverse outcome was found in 4 of 9 normothermic infants (44%) and 4 of 5 minimally cooled infants (80%), whereas in the combined mildly cooled groups, an adverse outcome was found in 4 of 15 infants (26%, odds ratio 0.46 [0.08, 2.56] vs normothermia).

Conclusions.  The present study supports the safety of hypothermia, with no evidence of late adverse effects in any infant. Among infants with moderate to severe encephalopathy at enrollment, there was a tendency toward better outcome. These results emphasize the relatively wide range of outcomes using purely clinical criteria for enrollment. Therapeutic hypothermia should not be used outside of stringent, multicenter trials.  Key words:  hypoxic-ischemic encephalopathy, asphyxia neonatorum, induced hypothermia, neurodevelopmental outcome.




This article has been cited by other articles:


Home page
 Arch Pediatr Adolesc MedHome page
P. S. Shah, A. Ohlsson, and M. Perlman
Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy: Systematic Review
Arch Pediatr Adolesc Med, October 1, 2007; 161(10): 951 - 958.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. S. Wyatt, P. D. Gluckman, P. Y. Liu, D. Azzopardi, R. Ballard, A. D. Edwards, D. M. Ferriero, R. A. Polin, C. M. Robertson, M. Thoresen, et al.
Determinants of Outcomes After Head Cooling for Neonatal Encephalopathy
Pediatrics, May 1, 2007; 119(5): 912 - 921.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
H. Tekgul, K. Gauvreau, J. Soul, L. Murphy, R. Robertson, J. Stewart, J. Volpe, B. Bourgeois, and A. J. du Plessis
The Current Etiologic Profile and Neurodevelopmental Outcome of Seizures in Term Newborn Infants
Pediatrics, April 1, 2006; 117(4): 1270 - 1280.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
Intracardiac temperature monitoring in infants after cardiac surgery.
J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 614 - 620.


Home page
 PediatricsHome page
C. M. Gebauer, M. Knuepfer, E. Robel-Tillig, F. Pulzer, and C. Vogtmann
Hemodynamics Among Neonates With Hypoxic-Ischemic Encephalopathy During Whole-Body Hypothermia and Passive Rewarming
Pediatrics, March 1, 2006; 117(3): 843 - 850.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. R. Blackmon, A. R. Stark, and and the Committee on Fetus and Newborn, American A
Hypothermia: A Neuroprotective Therapy for Neonatal Hypoxic-Ischemic Encephalopathy
Pediatrics, March 1, 2006; 117(3): 942 - 948.
[Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A D Edwards and D V Azzopardi
Therapeutic hypothermia following perinatal asphyxia.
Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2006; 91(2): F127 - F131.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. A. Rutherford, D. Azzopardi, A. Whitelaw, F. Cowan, S. Renowden, A. D. Edwards, and M. Thoresen
Mild Hypothermia and the Distribution of Cerebral Lesions in Neonates With Hypoxic-Ischemic Encephalopathy
Pediatrics, October 1, 2005; 116(4): 1001 - 1006.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
Z. A. Bhutta, G. L. Darmstadt, B. S. Hasan, and R. A. Haws
Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence
Pediatrics, February 1, 2005; 115(2/S1): 519 - 617.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. C. Morris, V. M. Nadkarni, F. R. Ward, and R. M. Nelson
Exception From Informed Consent for Pediatric Resuscitation Research: Community Consultation for a Trial of Brain Cooling After In-Hospital Cardiac Arrest
Pediatrics, September 1, 2004; 114(3): 776 - 781.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
J.P. Nolan, P.T. Morley, T.L. Vanden Hoek, R.W. Hickey, W.G.J. Kloeck, J. Billi, B.W. Bottiger, P.T. Morley, J.P. Nolan, K. Okada, et al.
Therapeutic Hypothermia After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation
Circulation, July 8, 2003; 108(1): 118 - 121.
[Full Text] [PDF]

Home page
 PediatricsHome page
M. R. Battin, J. Penrice, T. R. Gunn, and A. J. Gunn
Treatment of Term Infants With Head Cooling and Mild Systemic Hypothermia (35.0{degrees}C and 34.5{degrees}C) After Perinatal Asphyxia
Pediatrics, February 1, 2003; 111(2): 244 - 251.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
A. J. Gunn and L. Bennet
Cerebral Hypothermia in the Management of Hypoxic-Ischemic Encephalopathy
NeoReviews, June 1, 2002; 3(6): e116 - 122.
[Full Text]