5 Years Analysis of Therapeutic Hypothermia for HIE Neonates in NICUs of Ain Shams University

Abstract

Background Therapeutic hypothermia (TH) is a standard of care for neonatal Hypoxic Ischemic Encephalopathy (HIE) in developed countries. Most data come from High income countries (HIC). Recently, experts suggest that the safety and efficacy data on cooling from HIC should not be extrapolated to Low and Middle Income Countries (LMIC). Aim of the Work Evaluation of the outcome of neonates with HIE treated with TH as a neuroprotective treatment who were admitted to NICUs of Ain Shams University from 1/2016 to 12/2020. Patients and Methods All HIE babies who were treated with TH were included. Retrospectively, patients’ medical paper notes of included babies were reviewed, recorded, and analyzed. Survived neonates were approached by telephone interview regarding parental views on their neurodevelopment and were offered a formal neurodevelopmental assessment for their babies using Bayley Scales III. Results A total 37 neonates (17 survived and 20 died) were included: 2 mild HIE (survived), 13 severe HIE (all died) and 22 moderate HIE (15 survived and 7 died) (mortality 54.1%). The most common causes of death are pulmonary hemorrhage (24.3%) and shock (18.9%). Of the 17 survivors, 6 patients couldn’t be reached while 9 patients had satisfactory neurodevelopmental progression as per their parents while 2 patients had poor outcome. Bayley III was done for only 3 babies: All had normal cognitive and language development. 2 of them had normal motor development while 1 patient had mild to moderate motor delay. Conclusion TH might not improve outcome of sever HIE but of great value on outcome of moderate HIE. Prospective RCTs are recommended to assess the role of TH as a neuroprotective agent for neonates with HIE in a low resource setting.