Determinants of Outcome After Head Cooling for Neonatal Encephalopathy

Abstract

If the inhabitants of Olympus were to set 10 tasks for Hercules in perinatology, then the prevention and limitation of neurologic injury would be high on the list, along with the prevention of preeclampsia, prematurity, postpartum hemorrhage, and the impact of poverty on pregnancy outcome. The Cool Cap (Olympic Medical, Seattle, WA)1 Trial is a step along this path. The role of this technology is as-yet uncertain, its long-term benefits are unclear, and its safety profile is still incompletely defined. However, given the frequency of adverse outcomes in this group (>60% in the whole cohort), the promising outcomes of the original randomized trials strongly suggest that cooling will be an important part of our armamentarium in the years ahead. The latest article2 from the group presents an exploratory posthoc analysis of the data from the Cool-Cap Trial for the purpose of hypothesis generation to inform additional studies of factors that may influence the outcome of treatment. The original study (and, therefore, the conclusions drawn from it) was, to some extent, held hostage by the difficulties inherent in the prospective diagnosis of hypoxic-ischemic encephalopathy (HIE). This subgroup of infants with newborn encephalopathy is of particular interest because of the association with acute intrapartum problems. A pathology that is in evolution at the time of birth may be reversible. Unfortunately, the criteria used to demonstrate a hypoxic-ischemic etiology as set out in the study's inclusion criteria (ie, Apgar score of ≤5 at 10 minutes, need for resuscitation at … Address correspondence to John M. Keogh, FRANZCOG, Obstetrics and Gynaecology, Hornsby Hospital, Palmerston Road, Hornsby, New South Wales 2077, Australia. E-mail: keoghj1{at}optushome.com.au