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Selective cerebral hypothermia for post-hypoxic neuroprotection in neonates using a solid ice cap.
A R Horn1, D L Woods, C Thompson
1Neonatal Medicine, School of Child and Adolescent Health, University of Cape Town, South Africa.
Summary
Selective head cooling for hypoxic ischaemic encephalopathy in newborns showed inconsistent temperature control. While inducing systemic hypothermia, this method had significant regional temperature variations, indicating it may not be ideal for selective cerebral cooling.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Therapeutic Hypothermia
Background:
- Hypoxic ischaemic encephalopathy (HIE) is a serious condition in newborns.
- Selective head cooling is a potential treatment for HIE.
- A simple, cost-effective method for selective head cooling was investigated.
Purpose of the Study:
- To evaluate the safety and efficacy of selective head cooling with mild systemic hypothermia in newborns with HIE.
- To assess a novel, cost-effective cooling technique.
Main Methods:
- A randomized controlled trial was planned but halted after preliminary data from 4 infants.
- Hypothermia was induced using an insulated ice cap on the infant's head.
- Target rectal temperature: 35-35.5°C; target scalp temperature: 10-28°C.
Main Results:
- Systemic hypothermia was achieved, but significant temperature variations occurred in 3 of 4 infants.
- Nasopharyngeal temperature monitoring was unreliable; back temperature correlated best with rectal temperature.
- Adverse events included agitation and shivering, requiring sedation; no irreversible harm was noted.
Conclusions:
- The ice cap method induced systemic hypothermia but lacked selective cerebral cooling efficacy due to temperature fluctuations.
- Modifications to insulation reduced temperature variation but compromised selective cooling.
- Further research into uniform cooling methods or lower core temperatures (33-34°C) is recommended.
