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Does head cooling with mild systemic hypothermia affect requirement for blood pressure support?
Malcolm R Battin1, Marianne Thoresen, Elizabeth Robinson
1Newborn Services, National Women's Health, Auckland City Hospital, Private Bag 92 024, Auckland, New Zealand. malcolmb@adhb.govt.nz
Pediatrics
|March 4, 2009
Summary
Head cooling for neonatal encephalopathy did not increase initial need for volume or inotropes. However, physicians provided prolonged pressure support to cooled infants, suggesting a behavioral change in managing neonatal encephalopathy.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Critical Care Medicine
Background:
- Neonatal encephalopathy (NE) is a serious condition in newborns.
- Mild systemic hypothermia is a potential treatment for NE.
- The impact of hypothermia on hemodynamic support in NE is not fully understood.
Purpose of the Study:
- To determine if head cooling with mild systemic hypothermia for NE increases the need for volume or inotrope support.
- To investigate the relationship between mean arterial blood pressure and hemodynamic support in cooled vs. control NE infants.
Main Methods:
- A multicenter randomized controlled trial (CoolCap trial) involving term infants with moderate-to-severe NE.
- Infants were randomly assigned to 72 hours of head cooling or conventional care.
- Primary outcome: time relationship between mean arterial blood pressure and subsequent inotrope/volume administration.
Main Results:
- No difference in mean arterial blood pressure or initial inotrope/volume use between groups in the first 24 hours.
- Significantly lower heart rate observed during cooling.
- From 24-76 hours, cooled infants received more frequent pressure support, indicating slower withdrawal of therapy.
Conclusions:
- Mild systemic hypothermia does not alter initial hemodynamic support needs in NE.
- Physician behavior regarding pressure support withdrawal appears influenced by cooling treatment.
- Further research is needed to understand long-term hemodynamic implications and optimize treatment protocols.
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