Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy

Gunn, Alistair J., Wyatt, John S., Whitelaw, Andrew, Barks, John, Azzopardi, Denis, Ballard, Roberta, Edwards, A. David, Ferriero, Donna M., Gluckman, Peter D., Polin, Richard A., Robertson, Charlene M. and Thoresen, Marianne CoolCap Study Group (2008) Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy. Journal of Pediatrics, 152, (1), 55-58. (doi:10.1016/j.jpeds.2007.06.003). (PMID:18154900).


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OBJECTIVE: To evaluate whether therapeutic hypothermia alters the prognostic value of clinical grading of neonatal encephalopathy. STUDY DESIGN: This study was a secondary analysis of a multicenter study of 234 term infants with neonatal encephalopathy randomized to head cooling for 72 hours starting within 6 hours of birth, with rectal temperature maintained at 34.5 degrees C +/- 0.5 degrees C, followed by re-warming for 4 hours, or standard care at 37.0 degrees C +/- 0.5 degrees C. Severity of encephalopathy was measured pre-randomization and on day 4, after re-warming, in 177 infants; 31 infants died before day 4, and data were missing for 10 infants. The primary outcome was death or severe disability at 18 months of age. RESULTS: Milder pre-randomization encephalopathy, greater improvement in encephalopathy from randomization to day 4, and cooling were associated with favorable outcome in multivariate binary logistic regression. Hypothermia did not affect severity of encephalopathy at day 4, however, in infants with moderate encephalopathy at day 4, those treated with hypothermia had a significantly higher rate of favorable outcome (31/45 infants, 69%, P = .006) compared with standard care (12/33, 36%). CONCLUSION: Infants with moderate encephalopathy on day 4 may have a more favorable prognosis after hypothermia treatment than expected after standard care.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.jpeds.2007.06.003
ISSNs: 0022-3476 (print)
1097-6833 (electronic)
Subjects: R Medicine > RM Therapeutics. Pharmacology
R Medicine > RJ Pediatrics
Divisions : University Structure - Pre August 2011 > School of Medicine > Developmental Origins of Health and Disease
ePrint ID: 61187
Accepted Date and Publication Date:
January 2008Published
Date Deposited: 09 Oct 2008
Last Modified: 31 Mar 2016 12:44

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