Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial
Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial
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DOI：
10.1136/adc.2008.146977
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发表时间：
2009-07-01
影响因子：
4.4
通讯作者：
Brocklehurst, P.
中科院分区：
文献类型：
--
作者：
Azzopardi, D.;Strohm, B.;Brocklehurst, P.
背景：这是一项针对2006年12月至2008年2月在英国托比冷却登记处登记的婴儿的4期研究。该登记研究是在2006年11月底完成的TOBY围产期窒息后全身低温治疗随机试验的招募后建立的。方法：我们收集了患者特征、出生时状况、复苏细节、脑病严重程度、每小时体温记录、临床并发症和出院前结局的信息。研究了120名中位妊娠40（IOR 38-41）周出生的婴儿，出生时体重中位数为3287（IOR 2895-3710）g。出生后54 min内（IQR 2 h-5 h 32 min）开始冷却，中位数为3。除三名婴儿外，所有婴儿都接受了全身冷却。冷却期6 - 72 h的平均（SD）直肠温度为33.57 ℃（0.51 ℃）。每日脑病评分下降：出生后1-4天的中位数（IQR）分别为11（6-15）、9.7（5- 1 - 4）、8（5-13）和7（2-12）。51%的婴儿在中位数（范围）为9（4-24）天时建立了完全经口喂养。26%的研究婴儿死亡。多数病例的MRI表现与缺氧缺血相一致。临床并发症不被认为是由于hypothemi.Conclusion：在英国，治疗性低温围产期窒息后越来越多地被提供。成功达到目标体温，观察到的临床并发症不是由于体温过低。低温治疗可能防止了窒息后常见的脑病恶化。
Background: This is a phase 4 study of infants registered with the UK TOBY Cooling Register from December 2006 to February 2008. The registry was established on completion of enrolment to the TOBY randomised trial of treatment with whole body hypothermia following perinatal asphyxia at the end of November 2006.Methods: We collected information about patient characteristics, condition at birth, resuscitation details, severity of encephalopathy, hourly temperature record, clinical complications and outcomes before hospital discharge.Results: 120 infants born at a median of 40 (IOR 38-41) weeks' gestation and weighing a median of 3287 (IOR 2895-3710) g at birth were studied. Cooling was started at a median of 3 in 54 min (IQR 2 h-5 h 32 min) after birth. All but three infants underwent whole body cooling. The mean (SD) rectal temperature from 6 to 72 h of the cooling period was 33.57 degrees C (0.51 degrees C). The daily encephalopathy score fell: median (IQR) 11 (6-15), 9.7 (5-14), 8 (5-13) and 7 (2-12) on days 1-4 after birth, respectively. 51% of the infants established full oral feeding at a median (range) of 9 (4-24) days. 26% of the study infants died. MRI was consistent with hypoxia-ischaemia in most cases. Clinical complications were not considered to be due to hypothermia.Conclusion: In the UK, therapeutic hypothermia following perinatal asphyxia is increasingly being provided. The target body temperature is successfully achieved and the clinical complications observed were not attributed to hypothermia. Treatment with hypothermia may have prevented the worsening of the encephalopathy that is commonly observed following asphyxia.