Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e791-e798 (doi:10.1542/peds.2008-0456)

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ARTICLE

Outcomes of Safety and Effectiveness in a Multicenter Randomized, Controlled Trial of Whole-Body Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

Seetha Shankaran, MD^a, Athina Pappas, MD^a, Abbott R. Laptook, MD^b, Scott A. McDonald, BS^c, Richard A. Ehrenkranz, MD^d, Jon E. Tyson, MD, MPH^e, Michelle Walsh, MD, MS, Epi^f, Ronald N. Goldberg, MD^g, Rosemary D. Higgins, MD^h, Abhik Das, PhD^c for the NICHD Neonatal Research Network

^a Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
^b Department of Pediatrics, Women and Infant's Hospital of Rhode Island, Providence, Rhode Island
^c Department of Statistics and Epidemiology, RTI International, Research Triangle Park, North Carolina
^d Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
^e Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas
^f Department of Pediatrics, Case Western University, Cleveland, Ohio
^g Department of Pediatrics, Duke University, Durham, North Carolina
^h Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland

BACKGROUND. Whole-body hypothermia reduced the frequency of death or moderate/severe disabilities in neonates with hypoxic-ischemic encephalopathy in a randomized, controlled multicenter trial.

OBJECTIVE. Our goal was to evaluate outcomes of safety and effectiveness of hypothermia in infants up to 18 to 22 months of age.

DESIGN/METHODS. A priori outcomes were evaluated between hypothermia (n = 102) and control (n = 106) groups.

RESULTS. Encephalopathy attributable to causes other than hypoxia-ischemia at birth was not noted. Inotropic support (hypothermia, 59% of infants; control, 56% of infants) was similar during the 72-hour study intervention period in both groups. Need for blood transfusions (hypothermia, 24%; control, 24%), platelet transfusions (hypothermia, 20%; control, 12%), and volume expanders (hypothermia, 54%; control, 49%) was similar in the 2 groups. Among infants with persistent pulmonary hypertension (hypothermia, 25%; control, 22%), nitric-oxide use (hypothermia, 68%; control, 57%) and placement on extracorporeal membrane oxygenation (hypothermia, 4%; control, 9%) was similar between the 2 groups. Non–central nervous system organ dysfunctions occurred with similar frequency in the hypothermia (74%) and control (73%) groups. Rehospitalization occurred among 27% of the infants in the hypothermia group and 42% of infants in the control group. At 18 months, the hypothermia group had 24 deaths, 19 severe disabilities, and 2 moderate disabilities, whereas the control group had 38 deaths, 25 severe disabilities, and 1 moderate disability. Growth parameters were similar between survivors. No adverse outcomes were noted among infants receiving hypothermia with transient reduction of temperature below a target of 33.5°C at initiation of cooling. There was a trend in reduction of frequency of all outcomes in the hypothermia group compared with the control group in both moderate and severe encephalopathy categories.

CONCLUSIONS. Although not powered to test these secondary outcomes, whole-body hypothermia in infants with encephalopathy was safe and was associated with a consistent trend for decreasing frequency of each of the components of disability.

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Key Words: hypoxic-ischemic encephalopathy • whole-body hypothermia • safety • effectiveness

Abbreviations: HIE—hypoxic-ischemic encephalopathy • NICHD—Eunice Kennedy Shriver National Institute of Child Health and Human Development • MDI—Mental Developmental Index • GMFCS—Gross Motor Functional Classification System • PPHN—persistent pulmonary hypertension of the newborn • CNS—central nervous system • ECMO—extracorporeal membrane oxygenation

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Accepted Jul 1, 2008.

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