Long-Term Outcome after Asphyxia and Therapeutic Hypothermia in Late Preterm Infants: A Pilot Study.

Hanne Lademann,Anna Janning,Dirk Olbertz,Karl Abshagen,Jan Däbritz

doi:10.3390/healthcare9080994

Hanne Lademann, Anna Janning + Show 3 more

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https://doi.org/10.3390/healthcare9080994

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Journal: Healthcare	Publication Date: Aug 4, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: University of Rostock, Klinikum Südstadt Rostock

Abstract

Therapeutic hypothermia (THT) is the recommended treatment for neuroprotection in (near) term newborns that experience perinatal asphyxia with hypoxic-ischemic encephalopathy. The benefit of THT in preterm newborns is unknown. This pilot study aims to investigate long-term outcomes of late preterm asphyctic infants with and without THT compared to term infants. The single-center, retrospective analysis examined medical charts of infants with perinatal asphyxia born between 2008 and 2015. Long-term outcome was assessed using the Bayley Scales of Infant Development 2 at the age of (corrected) 24 months. Term (n = 31) and preterm (n = 8) infants with THT showed no differences regarding their long-term outcomes of psychomotor development (Psychomotor Developmental Index 101 ± 16 vs. 105 ± 11, p = 0.570), whereas preterm infants had a better mental outcome (Mental Developmental Index 105 ± 13 vs. 93 ± 18, p = 0.048). Preterm infants with and without (n = 69) THT showed a similar mental and psychomotor development (Mental Developmental Index 105 ± 13 vs. 96 ± 20, p = 0.527; Psychomotor Developmental Index 105 ± 11 vs. 105 ± 15, p = 0.927). The study highlights the importance of studying THT in asphyctic preterm infants. However, this study shows limitations and should not be used as a basis for decision-making in the clinical context. Results of a multicenter trial of THT for preterm infants (ID No.: CN-01540535) have to be awaited.

Highlights

Hypoxic-ischemic encephalopathy (HIE) is a result of a severe asphyctic event resulting in a hypoperfusion by hypoxemic blood
Infants fulfilling the definition of perinatal asphyxia according to national guidelines, which is defined as clinical signs of an HIE and umbilical artery pH (UapH) below
A single preterm with THT showed a mild mental and psychomotor developmental delay at the age of 24 months. This result highlights the importance of studying THT in asphyctic late preterm infants

Summary

Introduction

Nearly a quarter of neonatal deaths are related to perinatal asphyxia [1]. Perinatal asphyxia describes the oxygen deficiency of the fetus, due to a disturbed gas exchange between maternal and fetal blood, either intrauterine or during the birth process [2]. Hypoxic-ischemic encephalopathy (HIE) is a result of a severe asphyctic event resulting in a hypoperfusion by hypoxemic blood. Fever and infection increase the sensitivity of the brain to a hypoxic episode [3]. A lack of oxygen induces an anaerobic cell metabolism. The resulting acidosis, oxidative stress and deficiency of adenosine triphosphate (ATP) cause global depolarization [4,5]. The resulting accumulation of glutamate in the extracellular space leads to an influx and an ion imbalance and a cytotoxic edema

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