Cooling in the real world: Therapeutic hypothermia in hypoxic-ischemic encephalopathy
Cooling in the real world: Therapeutic hypothermia in hypoxic-ischemic encephalopathy
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DOI：
10.1016/j.ejpn.2013.03.006
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发表时间：
2013-09-01
影响因子：
3.1
通讯作者：
Shevell, Michael I.
中科院分区：
文献类型：
--
作者：
Garfinkle, Jarred;Sant'Anna, Guilherme Mendes;Shevell, Michael I.
背景和目的：治疗性低温的益处尚未从神经病学临床的角度进行评估。我们的目的是报告实施局部区域治疗性低温方案对新生儿神经科门诊随访的存活缺氧缺血性脑病（HIE）婴儿的神经发育结局的影响。方法：回顾性分析1999年3月至2000年6月期间被诊断为HIE并符合治疗性低温合格标准的足月儿，2010. 2008年9月实施了低温治疗。结果的措施被二分法定义为：正常或不良的，其中包括脑瘫，全球发育迟缓，和epilepsy.Results：30名婴儿被列入治疗前低温组。31名婴儿接受了低温治疗，27名婴儿接受了充分的随访，并被纳入低温治疗后组。治疗前低体温婴儿的不良结局发生率显著较高（19/30 [63%] vs 4/27 [15%]; OR = 0.10; 95%CI，0.03-0.37; P < 0.001）。治疗前低温组新生儿临床癫痫发作更频繁（P = 0.012）。胎儿窘迫的频率，剖腹产率，Apgar评分，复苏的需要，脐带/初始血气，和程度的两个groups.Conclusions之间没有差异：在我们的机构实施区域治疗性低温方案大大降低了观察到的神经系统发病率的幸存的HIS婴儿在我们的新生儿神经科诊所。采用这种疗法的其他中心和诊所可以预期HIE婴儿结局的类似变化。(C)2013年欧洲儿科神经病学学会。由爱思唯尔有限公司出版。保留所有权利。
Background and aim: The benefits of therapeutic hypothermia have not been assessed from the perspective of the neurology clinic. We aimed to report the impact of the implementation of a local regional therapeutic hypothermia program on the neurodevelopmental outcomes of surviving hypoxic-ischemic encephalopathy (HIE) infants who were followed in the neonatal neurology clinic.Methods: Retrospective analysis of term infants referred to the neonatal neurology clinic after having been diagnosed with HIE and meeting eligibility criteria for therapeutic hypothermia between March 1999 and June 2010. Therapeutic hypothermia was implemented in September 2008. Outcome measures were dichotomously defined as: normal or adverse, which included cerebral palsy, global developmental delay, and epilepsy.Results: Thirty infants were included in the pre-therapeutic hypothermia group. Thirty-one infants received therapeutic hypothermia and 27 were adequately followed and included in the post-therapeutic hypothermia group. The frequency of an adverse outcome was significantly higher in the pre-therapeutic hypothermia infants (19/30 [63%] versus 4/27 [15%]; OR = 0.10; 95% CI, 0.03-0.37; P < 0.001). Neonatal clinical seizures were more frequent in the pre-therapeutic hypothermia group (P = 0.012). There were no differences regarding frequency of fetal distress, rate of caesarean sections, Apgar scores, need of resuscitation, cord/initial blood gases, and degrees of encephalopathy between the two groups.Conclusions: The implementation of a regional therapeutic hypothermia program in our institution has vastly reduced the observed neurological morbidity of surviving HIS infants followed in our neonatal neurology clinic. A similar change in outcomes of infants with HIE can be anticipated by other centers and other clinics adopting this therapy. (C) 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.