Outcomes of preterm infants treated with hypothermia for hypoxic-ischemic encephalopathy.

Published

Journal Article

BACKGROUND: Therapeutic hypothermia reduces the risk of death, or moderate to severe neurodevelopmental impairment (NDI) in term infants with hypoxic-ischemic encephalopathy (HIE). Reports of its safety and efficacy in preterm infants are scarce. OBJECTIVE: Report short and long-term outcomes of preterm infants with HIE who received therapeutic hypothermia. METHODS: A retrospective cohort analysis of all preterm infants <36 weeks' gestation with HIE who received whole body hypothermia in a single center from January 2007 to April 2015. The primary outcome was death or moderate to severe NDI defined by moderate or severe cerebral palsy, severe hearing or visual impairment, or cognitive score < 85 on the Bayley Scales of Infant Development III (BSID III) at 18-24 months' adjusted age. RESULTS: 30 infants with a median gestational age and birthweight of 35 weeks' (range; 33-35) and 2575 g (1850-4840) and a median first postnatal blood pH of 6.81 (6.58-7.14). Complications included coagulopathy (50%), early clinical seizures (43.3%), arterial hypotension (40%), persistent metabolic acidosis (37%) and thrombocytopenia (20%). Four infants died before or soon after discharge (18.2%). Eighteen surviving infants (69.2%) had follow up data; 7 of them had moderate to severe NDI (38.9%). Cognitive, motor and language mean composite BSID III scores were 84 (54-110), 83 (46-118), and 78 (46-112). Death or moderate to severe NDI occurred in 11/22 (50%) infants with known outcomes. CONCLUSION: Large randomized trials on efficacy and safety are needed in this highly vulnerable population as the incidence of complications and the combined outcome of death and NDI is concerning.

Full Text

Duke Authors

Cited Authors

  • Herrera, TI; Edwards, L; Malcolm, WF; Smith, PB; Fisher, KA; Pizoli, C; Gustafson, KE; Goldstein, RF; Cotten, CM; Goldberg, RN; Bidegain, M

Published Date

  • October 2018

Published In

Volume / Issue

  • 125 /

Start / End Page

  • 1 - 7

PubMed ID

  • 30144709

Pubmed Central ID

  • 30144709

Electronic International Standard Serial Number (EISSN)

  • 1872-6232

Digital Object Identifier (DOI)

  • 10.1016/j.earlhumdev.2018.08.003

Language

  • eng

Conference Location

  • Ireland