Effects of Hypothermia for Perinatal Asphyxia on Childhood Outcomes
Effects of Hypothermia for Perinatal Asphyxia on Childhood Outcomes
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DOI：
10.1056/nejmoa1315788
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发表时间：
2014-07-10
影响因子：
158.5
通讯作者：
Edwards, A. David
中科院分区：
文献类型：
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作者：
Azzopardi, Denis;Strohm, Brenda;Edwards, A. David
背景在全身低温治疗新生儿脑病试验（TOBY）中，窒息性脑病的新生儿接受低温治疗后，在18个月大时神经功能结局得到改善，但目前还不确定这种治疗是否会导致更长时间的-方法我们随机分配了325名胎龄为36周或更长的窒息性脑病新生儿接受单独的标准治疗（对照）或标准护理，在出生后6小时内将体温降至直肠温度33至34摄氏度72小时。我们评估了这些儿童在6至7岁时的神经认知功能。这项分析的主要结果是生存的频率与智商得分为85或higher.ResultsA共75 145名儿童（52%）在低温组与52 132（39%）在对照组生存的智商得分为85或以上（相对风险，1.31; P = 0.04）。低温组和对照组的儿童死亡比例相似（分别为29%和30%）。与对照组相比，低温组中存活的儿童中无神经系统异常的儿童更多（65/145 [45%] vs. 37/132 [28%];相对风险，1.60; 95%置信区间，1.15 - 2.22）。在幸存者中，与对照组相比，低温组的儿童脑瘫风险（21% vs. 36%，P = 0.03）和中度或重度残疾风险（22% vs. 37%，P = 0.03）显著降低;他们的运动功能评分也显著改善。有没有显着的组间差异，在父母的评估儿童的健康状况和结果的10个11 psychometric tests.ConclusionsModerate低温围产期窒息后，导致在儿童中期的神经认知功能的改善。
BackgroundIn the Total Body Hypothermia for Neonatal Encephalopathy Trial (TOBY), newborns with asphyxial encephalopathy who received hypothermic therapy had improved neurologic outcomes at 18 months of age, but it is uncertain whether such therapy results in longer-term neurocognitive benefits.MethodsWe randomly assigned 325 newborns with asphyxial encephalopathy who were born at a gestational age of 36 weeks or more to receive standard care alone (control) or standard care with hypothermia to a rectal temperature of 33 to 34 degrees C for 72 hours within 6 hours after birth. We evaluated the neurocognitive function of these children at 6 to 7 years of age. The primary outcome of this analysis was the frequency of survival with an IQ score of 85 or higher.ResultsA total of 75 of 145 children (52%) in the hypothermia group versus 52 of 132 (39%) in the control group survived with an IQ score of 85 or more (relative risk, 1.31; P = 0.04). The proportions of children who died were similar in the hypothermia group and the control group (29% and 30%, respectively). More children in the hypothermia group than in the control group survived without neurologic abnormalities (65 of 145 [45%] vs. 37 of 132 [28%]; relative risk, 1.60; 95% confidence interval, 1.15 to 2.22). Among survivors, children in the hypothermia group, as compared with those in the control group, had significant reductions in the risk of cerebral palsy (21% vs. 36%, P = 0.03) and the risk of moderate or severe disability (22% vs. 37%, P = 0.03); they also had significantly better motor-function scores. There was no significant between-group difference in parental assessments of children's health status and in results on 10 of 11 psychometric tests.ConclusionsModerate hypothermia after perinatal asphyxia resulted in improved neurocognitive outcomes in middle childhood.