Efficacy and safety of systemic mild hypothermia treatment for moderate or severe neonatal hypoxic-ischemic encephalopathy / 中华围产医学杂志

ABSTRACT

Objective To explore the efficacy and safety of systemic mild hypothermia in management of neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE).Methods A retrospective case-control study was conducted on 75 neonates with moderate or severe HIE,who were admitted to the Neonatal Intensive Care Unit of Teaching Hospital of Fujian Medical University (Quanzhou Children's Hospital) from January 1,2011 to May 31,2015.The 75 neonates were divided into two groups,the conventional treatment group (33 cases,control group) and the mild hypothermia treatment group (42 cases,hypothermia group).Sequential management protocol for all subjects was followed,including amplitude-integrated electroencephalogram (aEEG) before treatment,aEEG and brain MRI at one week after birth,neonatal behavioral neurological assessment (NBNA) on the 14th day after birth,and determination of mental and psychomotor development index with Bayley Scales of Infant and Toddler Developmental at 18 months old.Adverse reactions,serious disability cases and deaths during the study were also recorded.Two sample-t test and Chi-square test were as statistical methods.Results There were six death cases in the control group,but on one died in the hypothermia group.In the survivals,The maximum voltage and minimum voltage in the hypothermia group were higher at 7-day old than that before treatment [maximum voltage(31.3 ±2.4) vs (18.1± 2.2) μ V;minimum voltage(13.5±2.1) vs (6.1 ±1.5) μ V,t=8.591 and 5.314,both P ＜ 0.05],and also higher than that of control group [(25.2±3.1) and (9.3±3.1) μV,respectively,both P ≤ 0.05].Compared with the control group,there were more babies with normal head MRI [43％(18/42) vs 18％(6/33),x2=4.814,P ≤ 0.05] in the hypothermia group at 7-day old and less cases of severe disability [21％(9/42) vs 45％(15/33),x2=4.902,P ≤ 0.05] and deaths [0％(0/42) vs 18％(6/33),x2=6.098,P ≤ 0.05].Higher NBNA score at 14 day and Bayley developmental index at 18 months were shown in the hypothermia group than in the control (39.4±2.6 vs 35.3 ±2.4,t=3.316;mental development index96.3± 13.2 vs 84.3 ± 10.6,t=7.893;psychomotor development index98.2 ±16.8 vs 85.4±13.2,t=8.753,all P ≤ 0.05).The adverse effects of hypothermia treatment included electrolyte imbalance (n=12),abnormal blood glucose level (n=8),hepatic and renal dysfunction (n=7),infections (n=6) and bradycardiac (n=4),and no cold injury syndrome case was reported.However,none of the above had significant difference compared with the control group (P ＞ 0.05).Conclusions Systemic mild hypothermia treatment is effective in reducing mortality rate and major disability rate in neonates with moderate or severe HIE and improves the neuromotor development when babies grow up to 18-month-old.