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Published online September 30, 2005
PEDIATRICS Vol. 116 No. 4 October 2005, pp. 1001-1006 (doi:10.1542/peds.2005-0328)
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SPECIAL ARTICLE

Mild Hypothermia and the Distribution of Cerebral Lesions in Neonates With Hypoxic-Ischemic Encephalopathy

Mary A. Rutherford, FRCR, FRCPCH*, Denis Azzopardi, MD, FRCPCH{ddagger}, Andrew Whitelaw, MD, FRCPCH§, Frances Cowan, PhD, MRCPCH{ddagger}, S. Renowden, FRCR||, A. David Edwards, FMedSci*,{ddagger}, Marianne Thoresen, MD, PhD§,||

* Imaging Sciences Department, Robert Steiner Magnetic Resonance Unit
{ddagger} Department of Paediatrics, Imperial College, Hammersmith Hospital, London, United Kingdom
§ Department of Clinical Sciences, Child Health, Southmead and St Michael's Hospital, University of Bristol, Bristol, United Kingdom
|| Department of Neuroradiology, Frenchay Hospital, Bristol, United Kingdom

Hypothermia induced by whole-body cooling (WBC) and selective head cooling (SHC) both reduce brain injury after hypoxia-ischemia in newborn animals, but it is not known how these treatments affect the incidence or pattern of brain injury in human newborns. To assess this, 14 term infants with hypoxic-ischemic encephalopathy (HIE) treated with SHC, 20 infants with HIE treated with WBC, and 52 noncooled infants with HIE of similar severity were studied with magnetic resonance imaging in the neonatal period. Infants fulfilling strict criteria for HIE were recruited into the study after assessment of an amplitude-integrated electroencephalography (aEEG). Cooling was commenced within 6 hours of birth and continued for 48 to 72 hours. Hypothermia was not associated with unexpected or unusual lesions, and the prevalence of intracranial hemorrhage was similar in all 3 groups. Both modes of hypothermia were associated with a decrease in basal ganglia and thalamic lesions, which are predictive of abnormal outcome. This decrease was significant in infants with a moderate aEEG finding but not in those with a severe aEEG finding. A decrease in the incidence of severe cortical lesions was seen in the infants treated with SHC.

Key Words: brain imaging • hypothermia • hypoxic-ischemic encephalopathy • neonates

Abbreviations: HIE, hypoxic-ischemic encephalopathy • WBC, whole-body cooling • SHC, selective head cooling • aEEG, amplitude-integrated electroencephalography • BGT, basal ganglia and thalamus • PLIC, posterior limb of the internal capsule • WM, white matter

Accepted Jul 1, 2005.


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