Original Article

Journal of Perinatology (2006) 26, 180–184. doi:10.1038/sj.jp.7211412; published online 12 January 2006

Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

Z-L Lin1, H-M Yu2, J Lin3, S-Q Chen1, Z-Q Liang1 and Z-Y Zhang1

  1. 1Department of Neonatology, Yuying Children's Hospital of Wenzhou Medical College, Wenzhou, China
  2. 2Department of Pediatrics, Zhejiang University School of Medical, Hangzhou, China
  3. 3Department of Pediatrics, Mount Sinai School of Medicine, New York, USA

Correspondence: Dr Z-L Lin, Department of Neonatology, Yuying Children's Hospital of Wenzhou Medical College, Wenzhou 325027, China. E-mail: linzhenlang@hotmail.com

Received 14 June 2005; Revised 19 September 2005; Accepted 22 September 2005; Published online 12 January 2006.

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Abstract

Objective:

 

The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia.

Study design:

 

Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5–7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7–10 days of life.

Results:

 

A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (chi 2=15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32plusminus2 in the hypothermic group vs 28plusminus3 in the control group, P<0.01).

Conclusion

 

s: Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.

Keywords:

perinatal, asphyxia, hypoxic-ischemic encephalopathy, newborn, infant, induced, hypothermia

Abbreviations:

HIE, hypoxic-ischemic encephalopathy; TNP, nasopharyngeal temperature; TR, rectal temperature; CT scan, computed tomographic scan; NBNA, Neonatal Behavioral Neurological Assessment

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