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Brain cooling and eligible newborns: should we extend the indications?
1Neonatology-Neonatal Intensive Care Unit S. Croce and Carle Hospital, Cuneo, Italy. gancia.p@ospedale.cuneo.it
Insights
Therapeutic hypothermia is a standard treatment for hypoxic ischemic encephalopathy (HIE) in term infants, reducing mortality and disability. Further research is needed on its safety and efficacy in preterm infants and other neonatal conditions.
Area of Science:
- Neonatal neurology
- Pediatric critical care
- Therapeutic hypothermia
Background:
- Therapeutic hypothermia is standard care for term infants with hypoxic ischemic encephalopathy (HIE).
- Studies show reduced mortality and neurodevelopmental disability in term newborns with HIE.
- HIE in preterm infants differs pathologically and clinically from term infants.
Purpose of the Study:
- To review the current evidence and potential future applications of therapeutic hypothermia in neonatal brain injury.
- To highlight the need for safety and efficacy data in preterm infants and other neonatal conditions.
Main Methods:
- Systematic review and meta-analysis of human newborn studies.
- Review of animal experimental models.
- Discussion of ongoing and proposed clinical trials.
Main Results:
- Therapeutic hypothermia reduces mortality and disability in term infants with HIE.
- Favorable effects are more pronounced in less severe HIE cases.
- Limited data exists on the safety and efficacy of hypothermia in preterm infants.
Conclusions:
- Therapeutic hypothermia is beneficial for term infants with HIE.
- More research, including safety studies and randomized trials, is crucial for preterm infants, neonatal stroke, post-cardiac arrest, and necrotizing enterocolitis.
Abstract:
Therapeutic hypothermia (whole body or selective head cooling) is recognized as standard of care for brain injury control in term infants with perinatal hypoxic ischemic encephalopathy (HIE). Recent metanalyses and systematic reviews in human newborns have shown a reduction in mortality and long-term neurodevelopmental disability at 12-24 months of age, with more favourable effects in the less severe forms of HIE. HIE is most often noted in term newborns. Preterm infants can also suffer from HIE, but the clinical manifestations and pathology are different, involving subcortical gray matter injury in association with white matter damage. Several term and preterm animal experimental models showed that a reduction in brain temperature following a hypoxic-ischemic insult reduces energy expenditure and may reduce histological neuronal loss, but little is known on the safety of therapeutic hypothermia in preterm or very low birth weight (VLBW) infants. Hypothermia is one of the most promising future interventions for the treatment of acute ischemic stroke, and seems to improve survival and neurologic outcome after cardiac arrest in adults. Similarly, recent reviews have emphasized the possible role of therapeutic hypothermia after pediatric cardiac arrest, and a trial is ongoing to assess the benefits of induced hypothermia in pediatric traumatic brain injury. So far, there is a lack of data on other possible indications, i.e., neonates with stroke or after cardio-pulmonary resuscitation, and necrotizing enterocolitis. Carefully designed safety studies and large randomized trials for all the above conditions and especially for preterm infants should be planned.
