Therapeutic Hypothermia in Children

The clinical use of therapeutic hypothermia (TH) is established as a standard of care for neonates with perinatal asphyxia, for whom TH leads to improved neurologic outcome at 18-month recovery. TH has not proven effective in randomized trials of children with severe traumatic brain injury (TBI) or out-of-hospital cardiac arrest (CA). Despite a promising initial randomized-controlled study of TH in severe pediatric TBI [1], two further studies demonstrated decreased intracranial pressure during hypothermia but no difference in neurological outcome in children at 3 and 6 months of recovery and a possible increase in mortality in children treated with TH versus normothermia [2, 3]. The most recent study was stopped early for futility as safety concerns prompted for an interim analysis [3]. A study of TH for out-of-hospital CA in 260 children also showed no benefit at 1-year recovery [4]. In this chapter, we will discuss EEG monitoring in neonates after perinatal hypoxic ischemic encephalopathy (HIE) and in children in the context of CA, extracorporeal membrane oxygenation (ECMO), status epilepticus (SE), and acute liver failure. A summary of the effects of TH in neonates and children with respect to EEG changes during cooling and rewarming, the clinical applications of EEG in pediatrics, and its use for prognostication in pediatric brain insults is shown in Table 21.1.