TY  - CHAP
M1  - Book, Section
TI  - Therapeutic Hypothermia
A1  - Gomella, Tricia Lacy
A1  - Eyal, Fabien G.
A1  - Bany-Mohammed, Fayez
PY  - 2020
T2  - Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 8e
AB  - Therapeutic  hypothermia  (TH)  is  now  the  gold  standard  treatment  for  infants  with  moderate  to  severe  hypoxic  ischemic  encephalopathy,  whereby  the  infant’s  core  body  temperature  is  decreased  within  6  hours  after  birth  followed  by  slow  rewarming  for  neuroprotection.  This  treatment  slows  the  metabolic  rate  so  cells  can  recover  and  prevent  further  damage.  Neonatal  encephalopathy  can  be  due  to  different  causes;  care  providers  should  take  careful  assessment  of  possible  etiologies  because  this  could  lead  to  specific  therapy  that  may  improve  prognosis.  When  a  clear  diagnosis  of  hypoxia-ischemia  is  known  to  be  the  reason  for  moderate  to  severe  encephalopathy,  TH  is  implemented  if  the  infant  meets  the  criteria.  It  has  been  shown  to  improve  survival  and  outcome  and  reduce  the  risk  of  death  or  major  neurodevelopmental  disability  at  18  months  of  age  with  data  suggesting  that  the  long  term  benefits  resulted  in  improved  neurocognitive  outcomes  persisting  into  middle  childhood.  The  benefits  of  cooling  outweigh  the  short-term  risks  related  to  hypothermia.  Published  hypothermia  protocols  have  consistently  used  gestational  age  of  at  least  ≥36  weeks  at  birth  to  qualify  for  TH  and  starting  treatment  within  the  first  6  hours  after  birth  with  systemic  temperatures  between  33°C  and  35°C  and  continuing  treatment  for  a  total  of  72  hours.  Deviating  from  this  protocol  is  not  recommended  as  it  may  result  in  an  increase  in  adverse  outcomes;  longer  or  deeper  hypothermia  showed  an  increase  in  mortality.  Cooling  infants  who  are  <36  weeks’  gestation  is  not  recommended  because  of  insufficient  evidence  to  evaluate  risks  and  benefit  in  this  patient  population.  The  best  benefit  of  TH  is  when  it  is  started  before  6  hours  of  life,  but  there  may  be  a  small  benefit  and  low  risk  for  infants  with  moderate  HIE  who  have  it  started  between  6  and  24  hours  of  life.  A  Cochrane  review  provided  evidence  from  11  randomized  controlled  trials  (n  =  1505  infants)  that  TH  is  beneficial  in  term  and  late  preterm  newborns  with  moderate  to  severe  HIE.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/24
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1168356515
ER  -