NEONATAL ENCEPHALOPATHY TREATED BY MODERATE HYPOTHERMIA

围产期缺氧缺血（HI）仍然是新生儿护理中的一个严重问题。 向大脑供应含氧血液的中断可能导致神经元损伤、脑病和可能的死亡。 新生儿脑病（NE）发生在每1000名足月婴儿中有3-9名。 低温降低或抑制许多导致再灌注后神经元损伤的细胞事件，并在潜在的破坏性疾病过程中提供早期和相对简单的干预。在接受心脏和神经外科手术的成人和新生儿人群中，已经确定了HI期间短期全身低温的安全性和有效性。 长期全身低温（1-5天）的安全性和有效性已在成人头部创伤患者和17例交界性快速性心律失常新生儿中得到证实，但在HI新生儿人群中未得到证实。 在设计和进行这种干预的全面临床试验之前，我们需要验证干预方案的一致性并定义结果指标。在这项初步研究中，我们将在HI事件发生后6小时内连续招募72名新生儿，并在HI损伤后48小时内将他们随机分配至低温（33 ℃）或常温（37.5 ℃）。本研究将测试一定程度的全身低温，其可能具有最大的神经保护作用，并且基于对人类婴儿的研究和我们对5名足月新生儿的初步可行性研究，副作用很少。 我们将研究疗效和安全性指标，完善治疗方案和全面临床试验的目标人群。 我们将表明，全身性低温可以安全和统一开始在外围医院和运输的新生儿到三级保健中心。 在这种疾病过程中使用低温可能是开创性的，并深刻地改变了窒息新生儿的治疗方式，即使在大多数农村地区。 有关措施的安全性和有效性的低温，新的方法来识别新生儿在最初几个小时后的侮辱，和这些新生儿的结果预测的问题需要更好地定义之前，一个明确的临床试验。

Perinatal hypoxia-ischemia (HI) remains a serious problem in the care of newborns. Interruption in the supply of oxygenated blood to the brain may result in neuronal injury, encephalopathy and possibly death. Neonatal encephalopathy (NE) occurs in 3-9 of every 1000 term infants. Hypothermia decreases or inhibits many of the cellular events that lead to neuronal damage after reperfusion, and offers the advantage of an early and relatively uncomplicated intervention in a potentially devastating disease process. The safety and efficacy of short-term systemic hypothermia during HI has been established in adult and neonatal populations undergoing cardiac and neurosurgical procedures. The safety and efficacy of longer-term systemic hypothermia (1-5 days) has been substantiated in adult head trauma patients and in 17 newborns with junctional tachyarrhythmias, but not in this population of HI newborns. Before a full-scale clinical trial of this intervention is designed and conducted, we need to validate the uniformity of the intervention protocol and define outcome measures. In this pilot study we will enroll 72 successive newborns within 6 hours of an HI event, and randomly assign them to hypothermia (33 C) or normothermia (37.5 C) for 48 hours after HI insult. This study will test a degree of systemic hypothermia which may have the greatest neuroprotective effect with few adverse effects based on studies in human infants and our preliminary feasibility study of 5 term newborns. We will address measures of efficacy and safety, refine the treatment protocol and the target population for the full-scale clinical trial. We will show that systemic hypothermia can be safely and uniformly begun at outlying hospitals and during transport of newborns to a tertiary care center. The use of hypothermia in this disease process may be groundbreaking and profoundly change the way asphyxiated newborns are treated even in the most rural areas. Questions regarding measures of safety and efficacy of hypothermia, novel methods for identification of neonates in first few hours after the insult, and outcome predictions for these newborns need to be better defined prior to a definitive clinical trial.