COOLING FOR NEWBORNS WITH HIE

COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007, ISSUE 4. ART. NO: CD003311. DOI: 10.1002/14651858.CD003311.pub2. There is evidence that therapeutic hypothermia is beneficial to term newborns with HIE, and that cooling decreases death, without increasing major disability in survivors. Benefits of cooling on survival and neurodevelopment outweigh the shortterm adverse effectsJacobs SE, Hunt R, Tarnow-Mordi WO,Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic

BACKGROUND PRIMARY NEURONAL DEATH related to cellular hypoxia with primary energy failure SECONDARY NEURONAL DEATH after a latent period six hours, Hyperaemia, cytotoxic edema, mitochondrial failure, excitotoxins, nitric oxide synthesis, free radical damage and cytotoxic actions of activated microglia Associated with encephalopathy and seizure

HOW IS HYPOTHERMIA NEUROPROTECTIVE ? Modify cells programmed for apoptosis, leading to their survival. Reducing cerebral metabolic rate, glutamate release , toxic nitric oxide and free radicals Reduces energy expenditure, reduces histological neuronal loss

Aim: to lower the temperature of basal ganglia 32 -34 celsius. Whole body cooling may be physiologically harmful Selective head cooling Brain produces 70% of total body heat Mild systemic hypothermia. Significant reduction in deep brain temperature was achieved only when the core body temperature was lowered to 34

BASIS FOR HYPOTHERMIA

PRIMARY OBJECTIVES To determine the effect of therapeutic hypothermia on mortality, long-term neurodevelopmental disability SECONDARY OBJECTIVES : Adverse effects

SUBGROUP ANALYSES planned on the basis of: 1.Severity of HIE 2.Inclusion criteria:a) preterm vs term/near-term(>35 weeks) b) electrophysiological+clinical criteria vs. Clin criteria

3.Commencement time(6hours) 4.Cooling Method 5.Degree [core temperature] 6.Duration () 7.Quality of outcome assessment [high quality (> 18 months with formal psychological

PARTICIPANTS1.Newborn infants 2.Evidence of peripartum asphyxia one of criteria: a)Apgar