Therapeutic hypothermia for infants with hypoxic ischemic encephalopathy: A five years' single center experience in Kuwait.

Abstract

We aimed to evaluate the effect of therapeutic hypothermia (TH) on brain MRI findings, neurological outcome, and mortality in patients with perinatal hypoxic ischemic encephalopathy (HIE) and compare between two modalities of TH: whole body cooling (WBC) and selective head cooling (SHC). Sixty-two inborn babies with HIE admitted to the NICU of a Kuwaiti teaching hospital between 2006 and 2013 were retrospectively reviewed. Patients were divided into two groups: group 1 (2006-2008, n = 30) never received hypothermia, and group 2 (2009-2013, n = 32) treated with hypothermia. Group 2 patients were chronologically divided into two subgroups: 2a, the SHC, (2009-2010, n = 15) and 2b, the WBC, (2011-2013, n = 17). Brain MRI taken 7-10 days after birth, neurological status and mortality at time of hospital discharge were evaluated. Patients who received TH showed significantly fewer MRI hypoxic changes (P = 0.04) and had better neurological outcome. Their need for anticonvulsants diminished (P = 0.04). However, their need for inotropes and duration of mechanical ventilation were increased (P = 0.001 & 0.02 respectively). No significant difference in mortality was found between the two groups (P = 0.6). In regression analysis, only MRI hypoxic changes predicted the occurrence of neurological abnormalities (P = 0.001). No difference in brain MRI findings, neurological outcome and mortality was observed between subgroups 2a and 2b (P > 0.05). TH improved the neurological outcome of HIE patients but had no effect on mortality. There was no difference between the two modalities of TH on patients' outcome.