The Impact of Hypoxemia on the Development of Retinopathy of Prematurity in Infants Less Than 29 Weeks of Gestation.

OBJECTIVE: To study the impact of cumulative exposure to hypoxemia on the development of retinopathy of prematurity (ROP) in preterm infants less than 29 weeks' gestation. STUDY DESIGN: This is a retrospective analysis of the effect of cumulative exposure to hypoxemia during the first 10 weeks of life in preterm infants <29 weeks' gestation. Cumulative time spent at various levels of oxygen saturation was calculated by converting the daily percentage of time to minutes per day. Cumulative exposure to hypoxemia (cT<80 or oxygen saturation <80%) was calculated weekly and compared between outcomes. The primary outcome was the development of ROP requiring treatment. RESULTS: Cumulative hypoxemia exposure was significantly associated with ROP requiring treatment. When adjusted for other neonatal morbidities, only gestation was consistently associated with ROP requiring treatment. CONCLUSION: Cumulative exposure to hypoxemia in the first few weeks was not associated with ROP or treatment of ROP after adjustment for confounders.

Beneficence and Nonmaleficence in Treating Neonatal Hypoxic-Ischemic Brain Injury.

The successful clinical translation of therapeutic hypothermia offers the tantalizing possibility that further improvements in outcomes may be possible by combining cooling with other neuroprotective drugs. The challenge now is to select from a daunting range of potential treatments. The patient's best interest must be central to ethical decision making at all times. However, the beneficence or nonmaleficence of potential therapies is seldom clear for any individual patient at the time of testing new therapies. Clinical randomized controlled trials are generally acknowledged by the scientific community as the 'gold standard' for evaluating interventions in health care. Therefore, ethical trial design is of the utmost importance. This paper explores contrasting ethical perspectives on how to select new interventions to treat neonatal encephalopathy after perinatal hypoxia-ischemia.

Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis.

OBJECTIVE: To establish the evidence of therapeutic hypothermia for newborns with hypoxic ischemic encephalopathy(HIE). DATA SOURCES: Cochrane Central Register of Controlled Trials, Oxford Database of Perinatal Trials, MEDLINE, EMBASE, and previous reviews. STUDY SELECTION: Randomized controlled trials that compared therapeutic hypothermia to normothermia for newborns with HIE. INTERVENTION: Therapeutic hypothermia. MAIN OUTCOME MEASURES: Death or major neurodevelopmental disability at 18 months. RESULTS: Seven trials including 1214 newborns were identified. Therapeutic hypothermia resulted in a reduction in the risk of death or major neurodevelopmental disability(risk ratio [RR], 0.76; 95% CI, 0.69-0.84) and increase in the rate of survival with normal neurological function (1.63; 1.36-1.95) at age 18 months. Hypothermia reduced the risk of death or major neurodevelopmental disability at age 18 months in newborns with moderate HIE (RR, 0.67; 95% CI, 0.56-0.81) and in newborns with severe HIE (0.83; 0.74-0.92). Both total body cooling and selective head cooling resulted in reduction in the risk of death or major neurodevelopmental disability(RR, 0.75; 95% CI, 0.66-0.85 and 0.77; 0.65-0.93,respectively). CONCLUSION: Hypothermia improves survival and neurodevelopment in newborns with moderate to severe HIE.Total body cooling and selective head cooling are effective methods in treating newborns with HIE. Clinicians should consider offering therapeutic hypothermia as part of routine clinical care to these newborns.