Abstract
Background.Newborninfants who have undergone severe birth asphyxia have a high risk of neurological disorders and death. The most effective method for the treatment of hypoxic ischemic encephalopathy caused by intrapartum asphyxia is therapeutic hypothermia, or targeted temperature management. Currently, there are no large studies comparing its different methods, therefore theaim of our studywas to compare the effectiveness of device-induced and uncontrolled therapeutic hypothermia in newborn infants who underwent intrapartum asphyxia.Materialsand methods.Studydesign:weconducteda retrospective, longitudinal, cohort study in 39 newborn infants born in severe asphyxia and receiving uncontrolled therapeutic hypothermia (group 1), and in 48 newborn infants born in severe asphyxia and receiving device-induced therapeutic hypothermia (group 2). Statistical data processing was carried out using standard techniques.Results.The body temperature in newborn infants of both groups was reduced to 33.5 °C within the first hour, but when using uncontrolled therapeutic hypothermia, the body temperature fluctuated from 32 to 35 °C. Device-induced therapeutic hypothermia has a more effective neuroprotective effect as compared to uncontrolled hypothermia (p< 0.05) and more rapidly stabilizes metabolism in newborns due to a decrease in lactate levels (p < 0.05). In newborns device-induced therapeutic hypothermia stabilizes hemodynamics more quickly compared to uncontrolled therapeutic hypothermia (p < 0.05). Device-induced therapeutic hypothermia reduces the period of hospitalization in the neonatal intensive care unit (p < 0.05), the risk of cerebral edema (p < 0.05) and of the repeated episodes of seizures (p < 0.05).Conclusion.Using uncontrolled therapeutic hypothermia causes a high risk of unintentional fluctuations in rectal temperature towards both hypothermia and rewarming, which can aggravate the severe condition of newborn infants. Device-induced therapeutic hypothermia has a more effective neuroprotective effect.
Highlights
undergone severe birth asphyxia have a high risk of neurological disorders and death
most effective method for the treatment of hypoxic ischemic encephalopathy caused by intrapartum
we conducted a retrospective, longitudinal, cohort study in 39 newborn infants born in severe asphyxia
Summary
Исследование проводили в отделении реанимации и интенсивной терапии новорождённых ОГБУЗ «Иркутский городской перинатальный центр». Дизайн: ретроспективное, продольное, когортное исследование, проведённое у 39 новорождённых, рождённых в тяжёлой асфиксии и получавших неконтролируемую терапевтическую гипотермию при помощи охлаждающих термоэлементов (1-я группа), и у 48 новорождённых, рождённых в тяжёлой асфиксии и получавших аппаратную терапевтическую гипотермии при помощи аппарата «Allon 2001» (2-я группа). Учитывали: оценку по шкале Апгар на 1-й и 5-й минутах; оценку по шкале тяжести ГИЭ (по H.B. Sarnat и M.S. Sarnat); наличие судорог в первый час жизни и далее в динамике; длительность ИВЛ и применения кардиотонической поддержки. При объективном обследовании обращали внимание на неврологический статус и длительность пребывания в отделении реанимации и в отделении патологии новорождённых. Анализ статистической значимости различий осуществляли с использованием метода непараметрической статистики – U-теста Манна – Уитни. За критический уровень значимости было принято значение р < 0,05
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