Perinatal asphyxial encephalopathy

Associated with high morbidity and mortality.

Associated with a high risk of death or early neurodevelopmental imparment.

Survivors often experience cerebral palsy, functional disabilities, and cognitive impairment which develops later in childhood.

Randomized, controlled trials involving infants with asphyxial encephalopathy indicate moderate hypothermia of 33-34C for 72 hours, initiated within six hours after delivery, can reduce the risk of death or disability at 18-24 months of age and increase the rate of survival free of disability.

In two randomized controlled trials among infants the CoolCap trial and the National Institute of Child Health and Human development trial reported results for outcomes of infants at 18 months of age with asphyxial encephalopathy: only the NICHD trial showed a significant reduction in death or disability with hypothermia.

The Total Body Hypothermia for Neonatal Encephalopathy Trial (TOBY), a multicenter randomized control trial comparing intensive or intensive care with total body cooling for 72 hours in infants with asphyxial encephalopathy: no significant reduction in rate of death or severe disability but did result in improved neurological outcomes in survivors.

Rate of death or disability in hypothermia groups remain high at 44-55%.

Comparing longer duration of cooling at 120 hours and deeper cooling at 32*C vs 72 hours at 33.5C of hypothermia therapy among neonates who were ful term with moderate or severe hypoxia ischemic encephalopathy:no reduction in NICU deaths occurred(Shankaran S et al).

Leave a Reply

Your email address will not be published. Required fields are marked *