Clinical Profile, Mortality, and Short-term Outcome in Asphyxiated Neonates Receiving Therapeutic Hypothermia in a Limited Resource Setting: A Cohort Study

Document Type : Original Article

Authors

1 Pediatrics at Mahatma Gandhi Memorial Medical College, Indore, India

2 Pediatric Resident at Mahatma Gandhi Memorial Medical College, Indore, India

Abstract

Background: This study aimed to evaluate the effectiveness of therapeutic hypothermia (TH) among asphyxiated newborns for reducing mortality, adverse clinical events, and short-term outcomes in comparison to asphyxiated newborns not receiving TH.
Methods: This non-randomized cohort study was conducted at a tertiary care center. The statistical population of the study consisted of asphyxiated newborns admitted in the neonatal intensive care unit within 24 h of life meeting the laboratory and/or clinical criteria of severe birth asphyxia. Eligible newborns, who received TH, were labeled as recipients and those who did not receive TH were labeled as non-recipients.
Results: Out of 176 studied neonates, 89 cases received TH, while 87 of the subjects did not receive TH. The recipients of TH had a 15.3% lower mortality rate, compared to non-recipients (P<0.05). The incidence of adverse clinical events was similar among both groups. At the time of discharge, 73.2% and 56.8%, 92.6% and 70.1%, 30.4% and 46.2% of recipients and non-recipients were neurologically normal (P=0.01), able to breastfeed (P<0.05), and required anti-epileptics (P<0.05), respectively.
Conclusion It can be concluded that TH was an effective and feasible therapy with decreased death rate, better neurological status at discharge, and lesser need for anti-epileptics without increasing adverse clinical events at limited-resource settings using low-cost devices.
 
 

Keywords

References

  1. Lawn JE, Cousens S, Zupan J; Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet. 2005; 365(9462):891-900.
  2. National neonatology forum (2002–2003). Indian National Neonatal Perinatal Database. Available at: URL: http://www.newbornwhocc.org/pdf/nnpd_ report_2002-03.PDF; 2003.
  3. Robertson CM, Finer NN. Long-term follow-up of term neonates with perinatal asphyxia. Clin Perinatol. 1993; 20(2):483-500.
  4. Pin TW, Eldridge B, Galea MP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. Eur J Paediatr Neurol. 2009; 13(3):224-34.
  5. Committee on Fetus and Newborn, Papile LA, Baley JE, Benitz W, Cummings J, et al. (2014) Hypothermia and neonatal encephalopathy. Pediatrics 133: 1146-1150.
  6. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013; 2013(1):CD003311.
  7. Thayyil S, Costello A, Shankaran S, Robertson NJ. Therapeutic hypothermia for neonatal encephalopathy implications for neonatal units in India. Indian Pediatr. 2009; 46(4):283-9.
  8. Pauliah SS, Shankaran S, Wade A, Cady EB, Thayyil S. Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis. PLoS One. 2013; 8(3):e58834.
  9. Prashantha YN, Suman Rao PN, Nesargi S, Chandrakala BS, Balla KC, Shashidhar A. Therapeutic hypothermia for moderate and severe hypoxic ischaemic encephalopathy in newborns using low-cost devices - ice packs and phase changing material. Paediatr Int Child Health. 2019; 39(4):234-9.
  10. Bharadwaj SK, Bhat BV. Therapeutic hypothermia using gel packs for term neonates with hypoxic ischaemic encephalopathy in resource-limited settings: a randomized controlled trial. J Trop Pediatr. 2012; 58(5):382-8.
  11. Thomas N, Abiramalatha T, Bhat V, Varanattu M, Rao S, Wazir S, et al. Phase changing material for therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy - a multi-centric study. Indian Pediatr. 2018; 55(3):201-5.
  12. Thomas N, George KC, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting: a feasibility trial. Indian Pediatr. 2011; 48(6):445-51.
  13. Thayyil S, Oliveira V, Lally PJ, Swamy R, Bassett P, Chandrasekaran M, et al. Hypothermia for encephalopathy in low and middle-income countries (HELIX): study protocol for a randomised controlled trial. Trials. 2017; 18(1):432.
  14. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005; 353(15):1574-84.
  15. Dubowitz L, Mercuri E, Dubowitz V. An optimality score for the neurologic examination of the term newborn. J Pediatr. 1998; 133(3):406-16.
  16. Romeo DM, Ricci D, Brogna C, Mercuri E. Use of the hammersmith infant neurological examination in infants with cerebral palsy: a critical review of the literature. Dev Med Child Neurol. 2016; 58(3):240-5.
  17. Catherine RC, Ballambattu VB, Adhisivam B, Bharadwaj SK,
    Palanivel C. Effect of therapeutic hypothermia on the outcome in term neonates with hypoxic ischemic encephalopathy-a randomized controlled trial. J Trop Pediatr. 2021; 67(1):fmaa073.
  18. Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalo-pathy: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011; 165(8):692-700.
  19. Thayyil S, Ayer M, Guhan B, Marlow N, Shankaran S, Robertson N. Whole body cooling using phase changing material in neonatal encephalopathy: A pilot randomised control trial. Pediatr Acad Soc Meet. 2010; 9:43506.
  20. Cotten CM, Shankaran S. Hypothermia for hypoxic–ischemic encephalopathy. Exp Rev Obstet Gynecol. 2010; 5(2):227-39.
  21. Roberts CT, Stewart MJ, Jacobs SE. Earlier initiation of therapeutic hypothermia by non-tertiary neonatal units in victoria, Australia. Neonatology. 2016; 110(1):33-9.
  22. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009; 361(14):
    1349-58.
  23. Joy R, Pournami F, Bethou A, Bhat VB, Bobby Z. Effect of therapeutic hypothermia on oxidative stress and outcome in term neonates with perinatal asphyxia: a randomized controlled trial. J Trop Pediatr. 2013; 59(1):17-22.
  24. Shankaran S, Laptook AR, Tyson JE, Ehrenkranz RA, Bann CM, Das A, et al. Evolution of encephalopathy during whole body hypothermia for neonatal hypoxic-ischemic encephalopathy. J Pediatr. 2012; 160(4):567-72.e3.
  25. Weeke LC, Groenendaal F, Mudigonda K, Blennow M, Lequin MH, Meiners LC, et al. A novel magnetic resonance imaging score predicts neurodevelopmental outcome after perinatal asphyxia and therapeutic hypothermia. J Pediatr. 2018; 192:33-40.e2.
  26. Orbach SA, Bonifacio SL, Kuzniewicz MW, Glass HC. Lower incidence of seizure among neonates treated with therapeutic hypothermia. J Child Neurol. 2014; 29(11):1502-7.
  27. Gane BD, Bhat V, Rao R, Nandhakumar S, Harichandrakumar KT, Adhisivam B. Effect of therapeutic hypothermia on DNA damage and neurodevelopmental outcome among term neonates with perinatal asphyxia: a randomized controlled trial. J Trop Pediatr. 2014; 60(2):134-40.
  28. Ji X, Luo Y, Ling F, Stetler RA, Lan J, Cao G, et al. Mild hypothermia diminishes oxidative DNA damage and pro-death signaling events after cerebral ischemia: a mechanism for neuroprotection. Front Biosci. 2007; 12:1737-47.
  29. Orbach SA, Bonifacio SL, Kuzniewicz MW, Glass HC. Lower incidence of seizure among neonates treated with therapeutic hypothermia. J Child Neurol. 2014; 29(11):1502-7.
  30. Gane BD, Bhat V, Rao R, Nandhakumar S, Harichandrakumar KT, Adhisivam B. Effect of therapeutic hypothermia on DNA damage and neurodevelopmental outcome among term neonates with perinatal asphyxia: a randomized controlled trial. J Trop Pediatr. 2014; 60(2):134-40.
  31. Ji X, Luo Y, Ling F, Stetler RA, Lan J, Cao G, et al. Mild hypothermia diminishes oxidative DNA damage and pro-death signaling events after cerebral ischemia: a mechanism for neuroprotection. Front Biosci. 2007; 12:1737-47.

 

 

Iranian Journal of Neonatology
Volume 12, Issue 4
October 2021
Pages 70-76

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