scholarly journals Safety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy

2017 ◽  
Vol 183 ◽  
pp. 37-42 ◽  
Author(s):  
Rakesh Rao ◽  
Shamik Trivedi ◽  
Zachary Vesoulis ◽  
Steve M. Liao ◽  
Christopher D. Smyser ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Gestational Age ◽  
Hypoxic Ischemic Encephalopathy ◽  
Preterm Neonates ◽  
Short Term ◽  
Ischemic Encephalopathy

scholarly journals Apgar Scores at 10 Minutes and Outcomes in Term and Late Preterm Neonates with Hypoxic-Ischemic Encephalopathy in the Cooling Era

2018 ◽  
Vol 36 (05) ◽  
pp. 545-554 ◽  
Author(s):  
Marina Ayrapetyan ◽  
Kiran Talekar ◽  
Kathleen Schwabenbauer ◽  
David Carola ◽  
Kolawole Solarin ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Hypoxic Ischemic Encephalopathy ◽  
Preterm Neonates ◽  
Short Term ◽  
Apgar Scores ◽  
Significant Difference ◽  
The Brain ◽  
Ischemic Encephalopathy

Objective To determine the short-term outcomes (abnormal brain magnetic resonance imaging [MRI]/death) in infants born with a 10-minute Apgar score of 0 who received therapeutic hypothermia and compare them with infants with higher scores. Study Design This is a retrospective review of 293 neonates (gestational age ≥ 35 weeks) born between November 2006 and October 2015 admitted with hypoxic-ischemic encephalopathy who received therapeutic hypothermia. Results of brain MRIs were assessed by the basal ganglia/watershed scoring system. Short-term outcomes were compared between infants with Apgar scores of 0, 1 to 4, and ≥5 at 10 minutes. Results Eight of 17 infants (47%) with an Apgar of 0 at 10 minutes survived, having 4 (24%) without abnormalities on the brain MRI and 7 (41%) without severe abnormalities. There was no significant difference in the combined outcomes of “death/abnormal MRI” and “death/severe abnormalities on the MRI” between infants with Apgar scores of 0 and 1 to 4. Follow-up data were available for six of eight surviving infants, and none had moderate or severe neurodevelopmental impairment. Conclusion In the cooling era, 47% of infants with no audible heart rate at 10 minutes and who were admitted to the neonatal intensive care unit survived; 24% without abnormalities on the brain MRI and 41% without severe abnormalities.

scholarly journals Dexmedetomidine for Sedation of Neonates with HIE Undergoing Therapeutic Hypothermia: A Single-Center Experience

2018 ◽  
Vol 08 (03) ◽  
pp. e168-e173 ◽  
Author(s):  
Keliana O'Mara ◽  
Michael Weiss
Keyword(s):  
Therapeutic Hypothermia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Limited Data ◽  
Single Center ◽  
Short Term ◽  
Term Neonates ◽  
Risk Of Death ◽  
Single Center Experience ◽  
Dexmedetomidine Infusion ◽  
Ischemic Encephalopathy

AbstractHypoxic-ischemic encephalopathy (HIE) is a significant cause of morbidity and mortality in neonates. Therapeutic hypothermia reduces the risk of death or disability. Providing optimal sedation while neonates are undergoing therapeutic hypothermia is likely beneficial but may present therapeutic challenges. There are limited data describing the use of dexmedetomidine for sedation in patients undergoing therapeutic hypothermia. The objective of this study is to evaluate the efficacy and short-term safety of dexmedetomidine infusion for sedation in term neonates undergoing therapeutic hypothermia for HIE.

Effect of Hypothermia and Severity of Hypoxic-Ischemic Encephalopathy in the Levels of C-Reactive Protein during the First 120 Hours of Life

2019 ◽  
Vol 37 (07) ◽  
pp. 722-730
Author(s):  
Amaia Cilla ◽  
Juan Arnaez ◽  
Isabel Benavente-Fernández ◽  
Carlos Ochoa ◽  
Cristina Vega ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Study Design ◽  
Gestational Age ◽  
Peak Level ◽  
Older Age ◽  
Hypoxic Ischemic Encephalopathy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Ischemic Encephalopathy ◽  
Median Maximum

Objective This study aimed to describe normal C-reactive protein (CRP) levels of newborns diagnosed with hypoxic-ischemic encephalopathy (HIE) and assess the influence of therapeutic hypothermia (TH) and the severity of HIE. Study Design We prospectively recruited infants ≥35 weeks of gestational age diagnosed with HIE from 2000 to 2013 and compared CRP levels in the first 120 hours of life according to the severity of HIE and the use of TH, which was introduced in 2009. Results Moderate HIE was diagnosed in 115 newborns, severe HIE in 90 (hypothermia was performed in 151 cases), and mild HIE in 20. Cooled newborns showed lower levels of CRP in the first 34 hours, but reached higher median maximum CRP levels (15.4 vs. 8.5 mg/L), and at a significantly older age (53 vs. 17 hours). Levels of CRP in mild HIE were lower than those of moderate–severe forms. Moderate and severe HIE had similar CRP levels, but time to maximum CRP was significantly less in moderate cases. Conclusion CRP levels of mild HIE are similar to healthy newborns, while CRP elevations can be expected in newborns with moderate–severe HIE. TH produced a slower rise, with a higher and late maximum CRP peak level.

Effect of dexmedetomidine on heart rate in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia

2021 ◽  
pp. 1-8
Author(s):  
M. Elliott ◽  
J. Burnsed ◽  
K. Heinan ◽  
L. Letzkus ◽  
R. Andris ◽  
...  
Keyword(s):  
Heart Rate ◽  
Therapeutic Hypothermia ◽  
Gestational Age ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Hypoxic Ischemic Encephalopathy ◽  
Standardized Protocol ◽  
Significant Difference ◽  
Alternative Agent ◽  
Ischemic Encephalopathy

BACKGROUND: Sedation is recommended to optimize neuroprotection in neonates with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Dexmedetomidine is an alternative agent to opioids, which are commonly used but have adverse effects. Both TH and dexmedetomidine can cause bradycardia. In this study, we describe our experience with dexmedetomidine and fentanyl in neonates undergoing TH for HIE, with a focus on heart rate (HR). METHODS: We performed a retrospective chart review from 2011–2019 at a level IV NICU comparing sedation with dexmedetomidine (n = 14), fentanyl (n = 120), or both (n = 32) during TH for HIE. HR trends were compared based on sedation and gestational age. Neonates were included if they underwent TH and received sedation and were excluded if cooling was initiated past 24 hours(h) of life or required ECMO. RESULTS: Of the 166 neonates included, 46 received dexmedetomidine, 14 as monotherapy and 32 in combination with fentanyl. Mean hourly HR from 12–36 h after birth was significantly lower for infants on dexmedetomidine versus fentanyl monotherapy (91±9 vs. 103±11 bpm, p <  0.002). Dexmedetomidine was decreased or discontinued in 22 (47.8%) neonates, most commonly due to inadequate sedation with a low HR. Lower gestational age was associated with higher HR but no significant difference in dexmedetomidine-related HR trends. CONCLUSIONS: Despite an association with lower HR, dexmedetomidine may be successfully used in neonates with HIE undergoing TH. Implementation of a standardized protocol may facilitate dexmedetomidine titration in this population.

Case series of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy during extracorporeal life support

Perfusion ◽  
2020 ◽  
Vol 35 (7) ◽  
pp. 700-706
Author(s):  
Prasad Bhandary ◽  
John M Daniel ◽  
Sean C Skinner ◽  
Matthew K Bacon ◽  
Mina Hanna ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Series ◽  
Standard Of Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
Short Term ◽  
Ischemic Encephalopathy

Therapeutic hypothermia initiated within 6 hours of birth is currently the standard of care for the management of neonates with hypoxic-ischemic encephalopathy. Neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy are also at risk for severe respiratory failure and need for extracorporeal life support. The risks and benefits of therapeutic hypothermia for hypoxic-ischemic encephalopathy during extracorporeal life support are still not well defined. We report our experience of a case series of six neonates who underwent therapeutic hypothermia for hypoxic-ischemic encephalopathy during extracorporeal life support. We also report long-term neurodevelopmental follow-up from 6 to 24 months and add to the current body of evidence regarding feasibility, clinical experience, and short-term complications.

Visual outcomes in children with neonatal hypoxic ischemic encephalopathy treated with therapeutic hypothermia

2021 ◽  
Author(s):  
Jerry Hsu ◽  
Noreen Shaikh ◽  
Hantamalala Ralay Ranaivo ◽  
Andrea C. Pardo ◽  
Rebecca B. Mets-Halgrimson
Keyword(s):  
Therapeutic Hypothermia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Visual Outcomes ◽  
Ischemic Encephalopathy
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