Therapeutic Hypothermia for Hypoxic Ischaemic Encephalopathy in Singapore General Hospital: Two Patient Case Series and Review of Literature

Abstract

Neonatal encephalopathy affects 2–5/1000 live births and hypoxic ischaemic encephalopathy (HIE) is the major cause1. Therapeutic hypothermia reduces brain injury and improves the neurodevelopmental outcome.We are sharing our local experience in therapeutic hypothermia in the form of a case series of two patients. Our incidence of moderate to severe HIE is 0.6/1000 live births. Both patients were cooled for 72 hours.The challenges faced were mainly in the time taken for achieving the target temperature and the time needed for re-warming, which varied from one to six hours and 4–24 hours, respectively. Complications like hyponatremia, hypokalemia, sinus bradycardia and thrombocytopenia were noted. Amplitude integrated electroencephalogram (aEEG) remained abnormal post cooling for both babies. Clinical markers, aEEG and MRI head findings combine to prognosticate well for the neurodevelopmental outcomes.We need to be familiar with the protocol for timely implementation of cooling, whichever the cooling method. Concentrating these high-risk cases in selected tertiary centres capable of instituting cooling as well as long-term follow-up will ensure better outcomes.