Hypothermia for HIE

Editors Note: Four studies of hypothermia in the treatment of hypoxic-ischemic encephalopathy (HIE) were presented at this year’s meeting. None of these studies have been completed yet, and only study design, safety data and some short-term outcomes were reported.

Cool Cap Trial, presented by John Wyatt MD, University College of London , UK .
One hundred seventy-nine infants with moderate to severe HIE were recruited from 28 perinatal centers and randomly assigned to head cooling or control groups. The eligibility criteria included pH < 7.0, Apgar < 5 at 10 minutes, and an abnormal amplitude-integrated EEG. The head cooling was initiated within 5.5 hours of birth, and was regulated to achieve a rectal temperature of 34.5C for 72 hours. Sinus bradycardia was consistently seen during cooling. There was no increase in rates of major adverse events, acute mortality, or the incidence of severity of complications between groups. No outcome data has been analyzed yet.

Chinese Trial, presented by Bo Sun MD, Children’s Hospital, Fudan University, Shanghai, China .
This was another trial of selective head cooling for severe HIE. Eighty-eight term babies with HIE were randomly assigned to hypothermia or control group. Entry criteria and treatment regimen were similar to the Cool Cap study. Bradycardia (HR 100-110) was common during hypothermia. No other adverse effects were noted. Brain CT scans on day 5-7 and EEGs at 3 months were better in the treatment group. Neurodevelopmental assessments at 1 month were better in the infants who received hypothermia.

NICHD and Australian Trials
These trials looked at using whole body hypothermia for HIE rather than selective head cooling. Otherwise, the entry criteria and the duration/degree of cooling were similar. Only pilot study results were reported, and no significant adverse effects of hypothermia were noted. Multicenter randomized controlled trials are in progress.

Comment. If these studies confirm a benefit to hypothermia for HIE, then the next step will be to determine the optimal route, temperature and duration of therapy. The mechanism of action for this treatment also needs to be studied. ABK

Conference Highlights from : Vermont Oxford Annual Meeting and Hot Topics in Neonatology Washington, DC; Dec 7-10, 2002

Hypothermia for HIE

Conference Highlights from :
Vermont Oxford Annual Meeting and Hot Topics in Neonatology
Washington, DC; Dec 7-10, 2002