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Should therapeutic hypothermia be offered to babies with mild neonatal encephalopathy in the first 6 h after birth?

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)442-448
Number of pages7
JournalPediatric Research
Volume85
Early online date16 Jan 2019
DOIs
DateAccepted/In press - 30 Dec 2018
DateE-pub ahead of print - 16 Jan 2019
DatePublished (current) - 1 Mar 2019

Abstract

Infants with moderate to severe neonatal encephalopathy (NE) benefit significantly from therapeutic hypothermia, with reduced risk of death or disability. However, the need for therapeutic hypothermia for infants with milder NE remains unclear. It has been suggested that these infants should not be offered therapeutic hypothermia as they may not be at risk for adverse neurodevelopmental outcome and that the balance of risk against potential benefit is unknown. Several key questions need to be answered including first, whether one can define NE in the first 6 h after birth so as to accurately distinguish infants with brain injury who may be at risk for adverse neurodevelopmental consequences. Second, will treatment of infants with mild NE with therapeutic hypothermia improve or even worsen neurological outcomes? Although alternate treatment protocols for mild NE may be feasible, the use of the current approach combined with rigorous avoidance of hyperthermia and initiation of hypothermia as early as possible after birth may promote optimal outcomes. Animal experimental data support the potential for greater benefit for mild HIE compared with moderate to severe HIE. This review will summarize current knowledge of mild NE and the challenges to a trial in this population.

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    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Springer Nature at https://doi.org/10.1038/s41390-019-0291-1 . Please refer to any applicable terms of use of the publisher.

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