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Relationship between temperature variability and brain injury on magnetic resonance imaging in cooled newborn infants after perinatal asphyxia

Journal of Perinatology volume 37, pages 1032–1037 (2017)Cite this article

Subjects

Abstract

Objective:

The objective of the study was whether temperature management during therapeutic hypothermia correlates with the severity of brain injury assessed on magnetic resonance imaging in term infants with hypoxic-ischemic encephalopathy.

Study Design:

Prospectively collected register data from the National Asphyxia and Cooling Register of Switzerland were analyzed.

Result:

Fifty-five newborn infants were cooled for 72 h with a target temperature range of 33 to 34 °C. Individual temperature variability (odds ratio (OR) 40.17 (95% confidence interval (CI) 1.37 to 1037.67)) and percentage of temperatures within the target range (OR 0.95 (95% CI 0.90 to 0.98)) were associated with the severity of brain injury seen on magnetic resonance imaging (MRI). Neither the percentage of measured temperatures above (OR 1.08 (95% CI 0.96 to 1.21)) nor below (OR 0.99 (95% CI 0.92 to 1.07) the target range was associated with the severity of brain injury seen on MRI.

Conclusion:

In a national perinatal asphyxia cohort, temperature variability and percentage of temperatures within the target temperature range were associated with the severity of brain injury.

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References

  1. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG . Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; 1: CD003311.

    Google Scholar 

  2. Shankaran S, Laptook AR, Tyson JE, Ehrenkranz RA, Bann CM, Das A et al. Evolution of encephalopathy during whole body hypothermia for neonatal hypoxic-ischemic encephalopathy. J Pediatr 2012; 160 (4): 567–72.e3.

    Article  Google Scholar 

  3. Azzopardi D, Strohm B, Marlow N, Brocklehurst P, Deierl A, Eddama O et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med 2014; 371 (2): 140–149.

    Article  CAS  Google Scholar 

  4. Shankaran S, Pappas A, McDonald SA, Vohr BR, Hintz SR, Yolton K et al. Childhood outcomes after hypothermia for neonatal encephalopathy. N Engl J Med 2012; 366 (22): 2085–2092.

    Article  CAS  Google Scholar 

  5. Shankaran S, Laptook AR, McDonald SA, Higgins RD, Tyson JE, Ehrenkranz RA et al. Temperature profile and outcomes of neonates undergoing whole body hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatr Crit Care Med 2012; 13 (1): 53–59.

    Article  Google Scholar 

  6. Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE et al. Effect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial. JAMA 2014; 312 (24): 2629–2639.

    Article  CAS  Google Scholar 

  7. Thoresen M . Cooling after perinatal asphyxia. Semin Fetal Neonatal Med 2015; 20 (2): 65.

    Article  Google Scholar 

  8. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med 2013; 369 (23): 2197–2206.

    Article  CAS  Google Scholar 

  9. Zeiner A, Holzer M, Sterz F, Schorkhuber W, Eisenburger P, Havel C et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med 2001; 161 (16): 2007–2012.

    Article  CAS  Google Scholar 

  10. Laptook A, Tyson J, Shankaran S, McDonald S, Ehrenkranz R, Fanaroff A et al. Elevated temperature after hypoxic-ischemic encephalopathy: risk factor for adverse outcomes. Pediatrics 2008; 122 (3): 491–499.

    Article  Google Scholar 

  11. Laptook AR, McDonald SA, Shankaran S, Stephens BE, Vohr BR, Guillet R et al. Elevated temperature and 6- to 7-year outcome of neonatal encephalopathy. Ann Neurol 2013; 73 (4): 520–528.

    Article  Google Scholar 

  12. Brotschi B, Grass B, Ramos G, Beck I, Held U, Hagmann C et al. The impact of a register on the management of neonatal cooling in Switzerland. Early Hum Dev 2015; 91 (4): 277–284.

    Article  Google Scholar 

  13. Sarnat HB, Sarnat MS . Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10): 696–705.

    Article  CAS  Google Scholar 

  14. Barkovich AJ, Hajnal BL, Vigneron D, Sola A, Partridge JC, Allen F et al. Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems. AJNR Am J Neuroradiol 1998; 19 (1): 143–149.

    CAS  Google Scholar 

  15. Rutherford MA, Pennock JM, Counsell SJ, Mercuri E, Cowan FM, Dubowitz LM et al. Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy. Pediatrics 1998; 102 (2 Pt 1): 323–328.

    Article  CAS  Google Scholar 

  16. Busto R, Dietrich WD, Globus MY, Valdes I, Scheinberg P, Ginsberg MD . Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 1987; 7 (6): 729–738.

    Article  CAS  Google Scholar 

  17. Wood T, Osredkar D, Puchades M, Maes E, Falck M, Flatebo T et al. Treatment temperature and insult severity influence the neuroprotective effects of therapeutic hypothermia. Sci Rep 2016; 6: 23430.

    Article  CAS  Google Scholar 

  18. Sarkar S, Donn SM, Bapuraj JR, Bhagat I, Barks JD . Distribution and severity of hypoxic-ischaemic lesions on brain MRI following therapeutic cooling: selective head versus whole body cooling. Arch Dis Child Fetal Neonatal Ed 2012; 97 (5): F335–F339.

    Article  Google Scholar 

  19. Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA . Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012; 166 (6): 558–566.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Professor Frances Cowan for carefully reviewing this manuscript for its scientific content. The National Asphyxia and Cooling Register group: Aarau: Cantonal Hospital Aarau, Children's Clinic, Department of Neonatology (Th. Voelcker, Ph. Meyer); Basel: University Children's Hospital Basel (UKBB), Department of Neonatology (SM Schulzke, S Wellmann); Berne: University Hospital Berne, Department of Pediatric Intensive care (B Wagner, K Daetwyler); Chur: Children's Hospital Chur, Department of Neonatology (W Bär, B Scharrer); Lausanne: University Hospital (CHUV), Department of Neonatology (J-F Tolsa, A Truttmann, J Schneider); Geneva: University Hospital (HUG), Division of Neonatology (RE Pfister); Lucerne: Children's Hospital of Lucerne, Neonatal and Pediatric Intensive Care Unit (TM Berger, M Fontana); St Gallen: Children's Hospital St Gallen, Neonatal and Pediatric Intensive Care Unit (JP Micallef, I Hoigné); Zurich: University Hospital Zurich (3), Department of Neonatology (D Bassler, G Natalucci, M Adams); and University Children's Hospital Zurich, Department of Intensive Care and Neonatology (B Frey, V Bernet). BB was supported by a grant of the ‘Filling the Gap’ Program at the University of Zurich, Switzerland.

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Authors and Affiliations

  1. Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland

    B Brotschi

  2. Department of Pediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    R Gunny

  3. Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland

    C Rethmann

  4. Horten Centre for Patient Oriented Research and Knowledge Transfer, University Hospital Zurich, Zurich, Switzerland

    U Held

  5. Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland

    B Latal

  6. Department of Neonatology, University Hospital Zurich, Zurich, Switzerland

    C Hagmann

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  1. B Brotschi
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  2. R Gunny
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  3. C Rethmann
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  4. U Held
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  5. B Latal
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  6. C Hagmann
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on behalf of the National Asphyxia and Cooling Register Group

Corresponding author

Correspondence to B Brotschi.

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The authors declare no conflict of interest.

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Brotschi, B., Gunny, R., Rethmann, C. et al. Relationship between temperature variability and brain injury on magnetic resonance imaging in cooled newborn infants after perinatal asphyxia. J Perinatol 37, 1032–1037 (2017). https://doi.org/10.1038/jp.2017.96

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  • DOI: https://doi.org/10.1038/jp.2017.96

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