Determinants of outcomes after head cooling for neonatal encephalopathy

Wyatt, John S., Gluckman, Peter D., Liu, Ping Y., Azzopardi, Denis, Ballard, Roberta, Edwards, A. David, Ferriero, Donna M., Polin, Richard A., Robertson, Charlene M., Thoresen, Marianne, Whitelaw, Andrew and Gunn, Alistair J. (2007) Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics, 119, (5), 912-921. (doi:10.1542/peds.2006-2839).


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OBJECTIVE: The goal of this study was to evaluate the role of factors that may determine the efficacy of treatment with delayed head cooling and mild systemic hypothermia for neonatal encephalopathy. METHODS: A total of 218 term infants with moderate to severe neonatal encephalopathy plus abnormal amplitude-integrated electroencephalographic recordings, assigned randomly to head cooling for 72 hours, starting within 6 hours after birth (with the rectal temperature maintained at 34.5 +/- 0.5 degrees C), or conventional care, were studied. Death or severe disability at 18 months of age was assessed in a multicenter, randomized, controlled study (the CoolCap trial). RESULTS: Treatment, lower encephalopathy grade, lower birth weight, greater amplitude-integrated electroencephalographic amplitude, absence of seizures, and higher Apgar score, but not gender or gestational age, were associated significantly with better outcomes. In a multivariate analysis, each of the individually predictive factors except for Apgar score remained predictive. There was a significant interaction between treatment and birth weight, categorized as > or =25th or or =38 degrees C) in control infants was associated with adverse outcomes. Although there was a small correlation with birth weight, the adverse effect of greater birth weight in control infants remained significant after adjustment for pyrexia and severity of encephalopathy. CONCLUSIONS: Outcomes after hypothermic treatment were strongly influenced by the severity of neonatal encephalopathy. The protective effect of hypothermia was greater in larger infants

Item Type: Article
ISSNs: 0031-4005 (print)
Related URLs:
Keywords: neonatal encephalopathy, hypoxic/ischemic encephalopathy, induced hypothermia, birth weight, pyrexia
Subjects: R Medicine
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
R Medicine > RJ Pediatrics
Divisions: University Structure - Pre August 2011 > School of Medicine > Developmental Origins of Health and Disease
ePrint ID: 61618
Date Deposited: 08 Sep 2008
Last Modified: 06 Aug 2015 02:50

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