Whole-Body Hypothermia for Neonates With Hypoxic–Ischemic Encephalopathy

Abstract Objective This study aimed to determine the degree to which whole-body hypothermia (WBH) impacts hemodynamic and respiratory status during hypothermia and the subsequent rewarming period in neonates with hypoxic–ischemic encephalopathy (HIE). Study Design This is a retrospective study reviewing the medical records of infants treated with WBH. Data including oxygenation index (OI), ventilator efficiency index (VEI), fraction of inspired oxygen (FiO2), blood lactate level, heart rate (HR), and mean blood pressure (MBP) were collected from defined time points from the beginning, middle, and end of WBH and then every 2 hours from the beginning of rewarming for 14 hours thereafter. The analysis included 65 infants. Data were analyzed using a piecewise linear regression with a mixed-effect model. Results HR decreased during WBH and significantly increased during rewarming. Lactate level, OI, VEI, FiO2, and MBP all decreased during WBH but showed no significant change during and after rewarming. Conclusion There was a decrease in metabolic demand as measured by oxygen requirement, OI, HR, and MBP during WBH, but only HR increased during rewarming, with no significant change in the other parameters. Some of this effect may be explained by improvement in the respiratory condition over time.

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Effects of Whole Body Therapeutic Hypothermia on Gastrointestinal Morbidity and Feeding Tolerance in Infants with Hypoxic Ischemic Encephalopathy

International Journal of Pediatrics ◽

10.1155/2014/643689 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Kimberly M. Thornton ◽

Hongying Dai ◽

Seth Septer ◽

Joshua E. Petrikin

Keyword(s):

Therapeutic Hypothermia ◽

Median Time ◽

Retrospective Cohort ◽

Gastric Tube ◽

Hypoxic Ischemic Encephalopathy ◽

Tube Placement ◽

Whole Body ◽

Beneficial Effects ◽

Ischemic Encephalopathy ◽

Feeding Tolerance

Objective. This retrospective cohort study evaluated the effects of whole body therapeutic hypothermia (WBTH) on gastrointestinal (GI) morbidity and feeding tolerance in infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE).Study Design. Infants ≥ 35 weeks gestational age and ≥1800 grams birth weight with moderate-to-severe HIE treated from 2000 to 2012 were compared. 68 patients had documented strictly defined criteria for WBTH: 32 historical control patients did not receive WBTH (non-WBTH) and 36 cohort patients received WBTH.Result. More of the non-WBTH group infants never initiated enteral feeds (28% versus 6%;P=0.02), never reached full enteral feeds (38% versus 6%,P=0.002), and never reached full oral feeds (56% versus 19%,P=0.002). Survival analyses demonstrated that the WBTH group reached full enteral feeds (median time: 11 versus 9 days;P=0.02) and full oral feeds (median time: 19 versus 10 days;P=0.01) sooner. The non-WBTH group had higher combined outcomes of death and gastric tube placement (47% versus 11%;P=0.001) and death and gavage feeds at discharge (44% versus 11%;P=0.005).Conclusion. WBTH may have beneficial effects on GI morbidity and feeding tolerance for infants with moderate-to-severe HIE.

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