Hypoxic-ischemic encephalopathy (HIE) may
cause neurodevelopmental deficits and
death in infants. The rate of HIE in the
Compared with infants who received usual care, those who underwent cooling were significantly less likely to have died or have moderate or severe disability (collective rates of IQ, motor function, blindness, and hearing impairment) at age 18 to 22 months (44% vs. 62%). Adjustment for severity of encephalopathy at randomization did not change the results. Individual rates of cerebral palsy, blindness, and hearing impairment among survivors did not differ significantly between the two groups. The incidence of serious adverse events (e.g., hypotension, cardiac arrhythmia, or oliguria) was similar in the two groups.
Comment: These encouraging results suggest that whole-body cooling may be an effective therapy for hypoxic-ischemic encephalopathy in term and asphyxiated infants. In a previous randomized study of brain cooling for HIE, no differences in rates of death and disability were found. As noted by an editorialist, one explanation for the different results is that systemic whole-body hypothermia resulted in more rapid cooling than brain cooling alone. Unfortunately, many neonates with HIE are born in community hospitals, where quickly instituting such an intensive intervention as whole-body cooling may be difficult to accomplish. In addition, these results do not pertain to premature infants.
Published in Journal Watch Pediatrics and Adolescent Medicine December 30, 2005