Benefits of starting hypothermia treatment within 6\xa0h vs. 6\u201312\xa0h in newborns with moderate neonatal hypoxic-ischemic encephalopathy

Wen Jia,Wenbin Dong,Xiaoping Lei,Qingping Li

doi:10.1186/s12887-018-1013-2

Wen Jia, Wenbin Dong + Show 2 more

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https://doi.org/10.1186/s12887-018-1013-2

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Abstract

BackgroundIt has been suggested that mild hypothermia treatment of hypoxia-ischemic encephalopathy (HIE) should start within 6 h after HIE, but many children are admitted to the hospital > 6 h, particularly in developing areas. We aimed to determine whether hypothermia treatment could remain effective within 12 h after birth.MethodsAccording to their admission, 152 newborns were enrolled in the < 6 h and 6–12 h after HIE groups. All newborns received conventional treatment combined with mild head hypothermia therapy, according to our routine clinical practice. Some newborns only received conventional treatment (lacking informed consent). All newborns received amplitude-integrated electroencephalography (aEEG) monitoring for 4 h and neuron-specific enolase (NSE) measurement before and after 3 days of therapy.ResultsCompared to the conventional treatment, hypothermia significantly improved the aEEG scores and NSE values in all newborns of the < 6-h group. In the 6–12-h group, the aEEG scores (F = 5.67, P < 0.05) and NSE values (F = 4.98, P < 0.05) were only improved in newborns with moderate HIE. Hypothermia treatment seems to have no effect in newborns with severe HIE after 6 h (P > 0.05). Hypothermia improved the rates of neonatal death and 18-month disability (all P < 0.01).ConclusionsIn newborns with moderate HIE, starting hypothermia therapy < 6 h and 6–12 h after HIE showed curative effects. In those with severe HIE, only starting hypothermia therapy within 6 h showed curative effects.

Highlights

It has been suggested that mild hypothermia treatment of hypoxia-ischemic encephalopathy (HIE) should start within 6 h after HIE, but many children are admitted to the hospital > 6 h, in developing areas
It has been suggested that hypothermia treatment of HIE should start within 6 h after hypoxia ischemia [5], but many newborns are admitted to the hospital > 6 h after HIE, those living in rural areas
There were no significant differences among the subgroups for gestational age, birth weight, gender, delivery mode, 5-min Apgar score, HIE stage, and amplitude-integrated electroencephalography (aEEG) score

Summary

Introduction

It has been suggested that mild hypothermia treatment of hypoxia-ischemic encephalopathy (HIE) should start within 6 h after HIE, but many children are admitted to the hospital > 6 h, in developing areas. Hypothermia is a proven effective treatment of HIE and can improve survival and long-term prognosis of children [3, 4]. It has been suggested that hypothermia treatment of HIE should start within 6 h after hypoxia ischemia [5], but many newborns are admitted to the hospital > 6 h after HIE, those living in rural areas. The 6-h limit for hypothermia initiation comes from data suggesting that the effectiveness of hypothermia diminishes as time increases from the hypoxic ischemic event, with the closing of the therapeutic window occurring 5.5–8 h after the event [6]. The exact timing of the therapeutic window after HIE is mostly unknown in human newborns and needs to be further investigated [7]

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