Abstract
Background: Therapeutic hypothermia (TH) is the standard therapy for hypoxic-ischemic encephalopathy (HIE) and is associated with a wide range of physiological changes. Objective: We re-evaluated the effects of HIE and TH on bilirubin measurements following HIE in a center involved in the China cooling randomized controlled trial (RCT). Methods: Serial serum bilirubin concentrations measured during the first week of life were compared among the HIE + NT (normothermia) group, HIE + TH treatment group and control group (without HIE). Survivors of HIE were followed and assessed at approximately 2 years of age, and the results were correlated with peak bilirubin levels during the first week of life. Results: One hundred and thirty-eight infants were available for analysis. Significantly lower bilirubin levels were recorded in the HIE + NT group than in the controls (P<0.05). Significant differences were not observed among the patients in the HIE + NT group (mild to severe) or between the HIE + TH group and the HIE + NT group at any time point (P>0.05). The peak serum bilirubin concentrations recorded at 96 h of age showed a good correlation with the results of the Bayley Scales of Infant and Toddler Development, third edition (BSID-III) (P=0.02). Conclusion: Bilirubin potentially exerts a neuroprotective effect during the first week of life, and low temperature does not affect the possible antioxidant function of bilirubin during TH following HIE.
Highlights
Despite treatment with therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE), approximately 50% of treated newborns have disabilities at 12–18 months of age [1,2]
During the 8-year study period, 45 infants with HIE were randomized to the HIE + Therapeutic hypothermia (TH) group and 44 infants with HIE were randomized to the HIE + NT group
Asphyxiated infants had lower bilirubin concentrations in the first few days after birth than non-asphyxiated control infants who were admitted to our neonatal intensive care unit (NICU) during the same period or infants included in previously published studies [8]
Summary
Despite treatment with therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE), approximately 50% of treated newborns have disabilities at 12–18 months of age [1,2]. HIE is often associated with multiorgan dysfunction, and as the standard therapy for HIE, TH is associated with a wide range of physiological changes that affect almost every organ system and function. An awareness of these effects is essential for optimum management of these critical patients [3,4]. Patients with HIE were less likely to need or did not need phototherapy, and we speculate that bilirubin metabolism may be affected by HIE We tested this potential hypothesis by examining the relationship between serum bilirubin concentrations and HIE severity, as well as the correlation between the serum bilirubin content and long-term neurodevelopmental outcomes. Conclusion: Bilirubin potentially exerts a neuroprotective effect during the first week of life, and low temperature does not affect the possible antioxidant function of bilirubin during TH following HIE
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