Abstract
Despite the progress in perinatal care, perinatal asphyxia (PA) remains a significant problem in neonatology. The development of therapeutic hypothermia (TH) has improved the prognosis, but it still remains uncertain in hypoxic neonates. The evaluation of the severity of ischemia/hypoxia after birth is crucial to the choice of treatment, and with accurate long-term prognosis, appropriate further patient care can be planned. This article presents various methods for the preliminary assessment of brain damage and prognosis in newborns with PA treated with TH. The importance of assessing the neurological condition and the usefulness of laboratory and electrophysiological testing and imaging are discussed. New methods are also noted, which are at the stage of clinical trials. A combination of the prognostic tests presented in this article can provide greater prognostic accuracy for predicting long-term neurological outcomes in infants with hypoxic-ischemic encephalopathy (HIE) undergoing TH than either of these tests independently. Acknowledging the limitations of individual tools in certain clinical situations and the integration of the information available from multiple biomarkers may help improve the accuracy of prognostication.
Highlights
Despite recent advances in perinatal care, neonatal hypoxic–ischemic encephalopathy (HIE) is one of the most common causes of severe neurological deficit in children, present in approx. 15 out of 10,000 live births.[1]
Acknowledging the limitations of individual tools in certain clinical situations and the integration of the information available from multiple biomarkers may help improve the accuracy of prognostication
Therapeutic hypothermia (TH) is a method of treatment that has proven effective in protecting the brain against the effects of ischemia/hypoxia in neonates after perinatal asphyxia (PA); it is recommended in both term and near-term newborns.[3,4]
Summary
Despite recent advances in perinatal care, neonatal hypoxic–ischemic encephalopathy (HIE) is one of the most common causes of severe neurological deficit in children, present in approx. 15 out of 10,000 live births.[1]. According to the World Health Organization (WHO), perinatal asphyxia (PA) represents the 3rd most common cause of neonatal death (23%). This means that all over the world, almost 600,000 newborns die every year, and at least as many develop severe complications such as epilepsy, cerebral palsy and developmental delay due to acute perinatal sentinel events.[2]. The qualification criteria and contraindications for TH are adjusted as knowledge progresses and they are included in recommendations and standards for the treatment of newborns. In this age group, 2 methods of cooling are available: selective head hypothermia and whole body hypothermia. The incidence rate of HIE is known and TH is increasingly available, no accurate data on the frequency of this treatment are available
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