Evaluation and prognosis of neonates with asphyxia treated by hypothermia

Document Type : Original Article


1 Assistant professor of neonatology , Pediatric health research center ,Tabriz university of medical science .Tabriz /Iran.

2 Professor of pediatric neurology, Pediatric health research center ,tabriz university of medical science .

3 neonatologist ,tabriz university of medical science

4 pediatrician, Tabriz university of medical science .

5 MD,pediatric health research center .


Background: Asphyxia is a perinatal accident with a high mortality rate, therapeutic hypothermia in both head or whole body was suggested as effective therapeutic methods. In this study, we compare these methods in neonates with asphyxia.
Methods and Materials: 16 neonates with asphyxia in two hospitals including Alzahra(head hypothermia) and Taleghani hospital (total body hypothermia) went under the therapeutic hypothermia for 72 hours. Maintaining temperature controlled by several sensors precisely. Body cooling were performed on the trunk and limbs of the neonates. Temperature and vital signs controlled every 1 hour and biochemistry, and coagulation tests were performed regularly, early and late complications of patients including developmental disorders, were evaluated. Comparing two groups was performed using Chi square and Mann Whitney U test, on the software SPSS16 , p less than 0.05 was significant.
Results: 16 cases with gestation age of 38 ± 2weeks were enrolled. Of 9 cases by head cooling 1 patient died and 2 patients got mild developmental disorders. Of the 7 newborns of whole body cooling trail, 3 died and 1 got minor developmental disorders and one case showed major.. Feeding time (head group 5±2 , body group 8±5 days) and also discharge time (head group 15±8 days and body group 14±5 days ) had no significant differences .
Conclusion: It seems head hypothermia method is associated with a lower mortality than the whole body method. In the above sample size, the differences were not statistically significant. Performing these procedures on larger samples could be approval.


  1. Kumar R. Birth asphyxia in a rural community of north India. J Trop Pediatr. 1995; 41: 5-7.
  2. Holden KR, Mellits ED, Freeman JM. Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics. 1982; 70:165-76.
  3. Inder TE, Volpe JJ. Mechanisms of perinatal brain injury. Semin Neonatol. 2000; 5:3-16.
  4. Fay T. Early experiences with local and generalized refrigeration of the human brain. J Neurosurg. 1959; 16:239-59.
  5. Gunn AJ, Gluckman PD, Gunn TR. Selective head-coolingin newborn infants after perinatal asphyxia: a safety study. Pediatrics. 1998; 102:885-92.
  6. Shankaran S, Laptook A, Wright LL,  Ehrenkranz RA, Donovan EF, Fanaroff AA, et al. Whole-body hypothermia for neonatal encephalopathy: animal observations as a basis for a randomized, controlled pilot study in term infants. Pediatrics. 2002; 110:377-85.
  7. Saaed D, Goetzman BW, Gospe SM. Brain injury and protective effects of hypothermia using triphenyltetrazolium chloride in neonatal rat. Pediatr Neurol. 1993; 9:263-7.
  8. Westin B, Einhorning G. An experimental study of the human fetus with special reference to asphyxia neonatorum. Acta Paediatr Suppl. 1955; 44:79-81.
  9. Nakamura T, Miyamoto O, Sumitani K, Negi T, Itano T, Nagao S. Do rapid systemic changes of brain temperature have an influence on the brain. Acta Neurochir (Wien). 2003; 145:301-7.

10. Miller JA, Miller FS, Westin B. Hypothermia in the treatment of asphyxia neonatorum. Biol Neonate. 1964; 6:148.

11. Miller JA, Miller FS. Mechanisms of hypothermic protection against anoxia. Adv Exp Med Biol. 1972; 33:571-86.

12. Duhn R, Schoen EJ, Siu M. Subcutaneous fat necrosis with extensive calcification after hypothermia in two newborn infants. Pediatrics. 1968; 41:661-4.

13. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD Ferriero DM, et al. Selective head-coolingwith mild systemic hypothermia after neonatal encephalopathy: multicenter randomized trial. Lancet. 2005; 365; 663-70.

14. Shankaran S, Laptook AR, Poole WK. Hypothermia for perinatal asphyxial encephalopathy. N Engl J Med. 2010; 362:1051-2.

15. Mathur NB, Krishnamurthy S, Mishra TK. Evaluation of WHO classification of hypothermia in sick extramural neonates as predictor of fatality. J Trop Pediatr. 2005; 51:341-5.

16. Zhou WH, Shao XM, Cao Y, Chen C, Zhang XD. Safety study of hypothermia for treatment of hypoxice ischemic brain damage in term neonates. Acta Pharmacol Sinica. 2002; 23:64-8.