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ARTICLE:
Denis Azzopardi, Nicola J. Robertson, Frances M. Cowan, Mary A. Rutherford, Michael Rampling, and A. David Edwards
Pilot Study of Treatment With Whole Body Hypothermia for Neonatal Encephalopathy
Pediatrics 2000; 106: 684-694 [Abstract] [Full text] [PDF]
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P3Rs published:

[Read P3R] Hypothermia and encephalopathy
Shabih Manzar   (8 January 2001)
[Read P3R] Response to Dr Manzar
Denis Azzopardi   (9 January 2001)

Hypothermia and encephalopathy 8 January 2001
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Shabih Manzar,
Neonatologist
King Fahd Univ.Hosp.

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Re: Hypothermia and encephalopathy

shabihman{at}hotmail.com Shabih Manzar

January 7, 2001

Jerold F. Lucey, MD Editor Pediatrics Editorial office Fletcher Allen Health Care 111 Colchester Avenue Burlington, VT 05401 USA

Re: Whole body hypothermia for neonatal encephalopathy.

Sir,

I read with interest the recent article by Azzopardi et al (1) describing their relative success with whole body hypothermia in cases of neonatal encephalopathy. There are few points in the study that remain unclear to me.

What took it so long?

According to the footnote on the title page, the study was submitted in May 1994, which meant that the study was conducted in 1992 (for 18 months period). What took it so long to publish? My general impression is the possibility of typo error (1994 instead of 1999), as most of the cited references are from the year 1995 onwards.

What was the rationale of using ear temperature monitoring in addition to continuous rectal/skin temperature? I fully agree with the idea of having non-invasive methods for direct measurement of brain temperature. But does any thing like this exist or tried elsewhere?

Amplitude integrated electroencephalogram (aEEG) was performed before the treatment with hypothermia using a commercial air cooling system. It was not specified that who read the aEEG? the neurologist? the neonatologist? It is important to know if the study has to be reproduced.

A neurologist did the follow up neurological examination of the treated neonates. Was he blinded about the therapy? As that might bias the assessment.

Finally, the improvement outcome of 60% (6 out of 10), with regards to mortality and morbidity in the pilot study is promising. However, the ideal will be to assess the outcome mortality and morbidity in the group of neonates with abnormal aEEG without hypothermia treatment.

Yours sincerely,

Shabih Manzar, MD.,FAAP

Division of Neonatology Department of Pediatrics King Fahd University Hospital P.O.Box 40211 Al-Khobar 31952 Saudi Arabia

E-mail : shabihman@hotmail.com Tele/ Fax 00 966 3 897 6941

Reference:

1. Azzopardi D, Robertson NJ, Cowan FM, et al. Pilot study of treatment with whole body hypothermia for neonatal encephalopathy. Pediatrics 2000; 106: 684-694

Response to Dr Manzar 9 January 2001
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Denis Azzopardi,
Paediatrician
Imperial College School of Medicine

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Re: Response to Dr Manzar

d.azzopardi{at}ic.ac.uk Denis Azzopardi

We thank Dr Manzar for his interest in our publication. 1.The article was indeed submitted in 1999 not 1994. 2.We were interested in the performance of ear infrared thermometry during whole body cooling but did not use this as a surrogate for brain temperature. Microwave thermometry may be one technique that allows non invasive brain temperature monitoring in the future (See Pediatr Res 2000 48: 351-356 http://www.pedresearch.org/cgi/content/abstract/48/3/351). Brain temperature may also be measured noninvasively by magnetic resonance spectroscopy but this is not practical for clinical use. 3.aEEG was carried out and assessed by neonatologists as described in our previous paper (Pediatrics 1999 103: 1263-1271) http://www.pediatrics.org/cgi/content/full/106/4/684) Clinicians can reliably assess aEEG after relatively little training. 4.The neurologist who performed follow-up was not blinded to therapy. The primary aim of the pilot study was to assess the feasiblity of selecting infants and treating with whole body hypothermia within 6 hours of birth. A suitably powered randomised controlled study is required to assess efficacy and this is currently being planned.