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Elevated temperature and 6- to 7-year outcome of neonatal encephalopathy

Abbot R Laptook1, Scott A McDonald, Seetha Shankaran

  • 1Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, RI.

Annals of Neurology
|April 19, 2013
PubMed

Insights

Elevated body temperatures in infants after brain injury without cooling are linked to higher risks of death or low intelligence quotient (IQ). This finding highlights the importance of temperature management in neonatal intensive care.

Area of Science:

  • Neonatal neurology
  • Pediatric critical care
  • Neurodevelopmental outcomes

Background:

  • Hypoxia-ischemia (HI) is a major cause of neonatal brain injury.
  • Temperature management is crucial in neonatal care, but the impact of fever post-HI without therapeutic hypothermia requires further investigation.
  • Previous research suggests a link between hyperthermia and adverse outcomes in neonates.

Purpose of the Study:

  • To investigate the association between elevated postnatal temperatures and neurodevelopmental outcomes in infants treated with intensive care without hypothermia.
  • To determine if higher temperatures correlate with death or an intelligence quotient (IQ) below 70 at 6 to 7 years of age.
  • To assess the relationship between temperature and secondary outcomes like cerebral palsy (CP).

Main Methods:

  • A cohort of 106 control infants (noncooled) from a larger hypothermia trial was analyzed.
  • Serial esophageal and skin temperatures were recorded over 72 hours postnatally.
  • Logistic regression models were used to assess associations between temperature quartiles/medians and outcomes (death, IQ<70, CP) at 6-7 years.

Main Results:

  • Higher average esophageal and skin temperatures in the upper quartile were significantly associated with an increased risk of death or IQ<70 (OR 7.3 and 3.5, respectively).
  • Elevated esophageal and skin temperatures were also linked to a higher incidence of moderate/severe cerebral palsy (OR 12.5 and 10.3, respectively).
  • Primary outcome data were available for 89 infants, with 54 experiencing death or IQ<70.

Conclusions:

  • In noncooled infants following hypoxia-ischemia, elevated postnatal temperatures are associated with significantly worse neurodevelopmental outcomes.
  • These findings underscore the importance of vigilant temperature monitoring and management in neonatal intensive care units.
  • Further research may explore optimal temperature thresholds and interventions to mitigate risks associated with fever post-HI.
Abstract

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