Abstract
Introduction: Hypoxic ischemic encephalopathy (HIE) is the main cause of death or neurologic disability in the term newborn. Recent randomised controlled trials have shown that mild therapeutic hypothermia reduces death and neurologic disability in these infants. Thus therapeutic hypothermia is becoming standard of care for brain injury in infants with perinatal HIE.Objective: To compare rmortality and neurologic outcome of term neonates with HIE admitted to our NICU during two time periods, before and after introduction of the therapeutic controlled hypothermia.Patients and methods: 41 newborns (period 1: 2005-2007) and 20 newborns (period 2 : 2008-2010) were respectively studied. Anoxo-ischemic criteria were similar and neurological criteria used the Sarnat scoring. Infants with moderate or severe HIE (Sarnat 2 or 3) were treated with therapeutic hypothermia in period 2.Results: Mean gestational age (38.6 vs 38.5 weeks), outborn neonates (83% vs 95%) and mean arrival time in the unit (3.4 vs. 4.1 hours of life) were comparable. Mortality (44% vs 25%) and poor outcome (death or significant neurologic disability) (48.7% vs. 40%) decreased in the period 2 and normalised neurologic examination at seven days of age was more frequent in this period (44% vs. 60%). Survival with normal outcome or minor neurologic sequelae was similar during the two periods: 91% vs 80% at the median age of 42 months vs 12.1 months.Conclusion: Introduction of controlled therapeutic hypothermia for term HIE neonates decreased mortality without increasing short term major neurological neurodevelopmental disability in survivors. Initial neurologic evaluation with EEG or aEEG may improve our criteria for hypothermia.
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