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Therapeutic hypothermia is associated with changes in prognostic value of general movements

Fabrizio Ferrari1, Luca Bedetti2, Francesca Cavalleri3

  • 1Neonatal Intensive Care Unit, Women's and Children's Health Department University Hospital of Modena, Modena, Italy.

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society
|December 23, 2022
PubMed

Insights

Therapeutic hypothermia (TH) significantly reduces cerebral palsy (CP) rates in infants with hypoxic ischemic encephalopathy (HIE). Abnormal general movements (GMs) like hypokinesis and cramped-synchronized patterns are absent in cooled infants, altering their prognostic value.

Area of Science:

  • Neonatal neurology
  • Developmental pediatrics
  • Neurodevelopmental disorders

Background:

  • General movements (GMs) are key predictors of cerebral palsy (CP).
  • Hypoxic ischemic encephalopathy (HIE) is a major cause of CP in newborns.
  • Therapeutic hypothermia (TH) is a standard treatment for HIE.

Purpose of the Study:

  • To compare the types and prognostic value of abnormal GMs in HIE infants treated with or without TH.
  • To assess the impact of TH on GM patterns and CP prediction.

Main Methods:

  • Single-center retrospective study comparing GMs in cooled (n=55) versus non-cooled (n=30) HIE infants.
  • Assessment of motor outcomes at 24 months and early brain MRI scans.

Main Results:

  • CP rates were 5.4% in cooled vs. 46.7% in non-cooled infants (p < 0.001).
  • Cooled infants showed no hypokinesis or cramped-synchronized GMs; absent fidgety movements had reduced CP correlation.
  • Cooled infants had fewer and less severe brain lesions on MRI (p = 0.003).

Conclusions:

  • TH reduces abnormal GMs in HIE infants.
  • TH abolishes hypokinesis and cramped-synchronized GMs, altering the prognostic significance of absent fidgety movements.
  • TH is associated with improved neurodevelopmental outcomes and changes in GM prognostic value.
Abstract

Keywords:
Brain MRICerebral palsyGeneral movementsHypoxic ischemic encephalopathyNeurodevelopmental follow-upTherapeutic hypothermia

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