Treatment of term infants with head cooling and mild systemic hypothermia (35.0°C and 34.5°C) after perinatal asphyxia

ABBREVIATIONS. BP, blood pressure; HIE, hypoxic-ischemic encephalopathy; CT, computer tomographic; EEG, electroencephalographic; ECG, electrocardiogram; PPHN, persistent pulmonary hypertension. Hypothermia has been proposed as a therapeutic intervention to reduce secondary neuronal [...]
Objective. To assess the safety of selective head cooling in birth-asphyxiated term newborn infants while maintaining the rectal temperature at 35.0°C or 34.5°C. Methods. Twenty-six term infants with Apgar ≤ 6 at 5 minutes or cord/first arterial pH Results. One cooled infant died 2 days after rewarming, and 3 control infants died. Seizures occurred in 9 (69%) of 13 cooled infants and 5 (38%) of 13 control infants. Respiratory support within the first 72 hours of life was required in 10 of 13 infants in both the cooled and control groups. Three cooled infants and 1 control infant received nitric oxide for persistent pulmonary hypertension. During the same interval, 6 of the cooled infants and 4 of the control infants had episodes in which their blood pressure fell to Conclusions. This study suggests that selective head cooling combined with mild systemic hypothermia of 34.4°C or 35.0°C is a stable, well-tolerated method of reducing cerebral temperature in term newborn infants after perinatal asphyxia. Pediatrics 2003;111:244-251; asphyxia neonatorum, induced hypothermia, controlled trial, term neonate, hypoxic-ischemic encephalopathy.