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

Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy
Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy
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.
0022-3476
55-58
Gunn, Alistair J.
86d02028-3434-440d-8eae-f9c97938ee47
Wyatt, John S.
e0f73250-efa3-4bb6-adf6-ab0c92432ccb
Whitelaw, Andrew
eb4fbfaf-e060-46de-98ca-28ccdf551a1e
Barks, John
5928f8c7-0fa9-4482-b286-29eca51ae5c1
Azzopardi, Denis
1518088a-ed90-4a76-ac3b-274fef8cbeed
Ballard, Roberta
7f6967bd-7e19-40ee-aebf-73ec6a85742f
Edwards, A. David
221ff1ff-ee2c-4c16-b72e-5e84071dab29
Ferriero, Donna M.
e25ad321-9c72-45f2-9f94-3886d8faefcb
Gluckman, Peter D.
ef2e8b92-0b76-4a12-bd7c-01b0674f94d3
Polin, Richard A.
24811542-b299-4098-903c-8d405075e023
Robertson, Charlene M.
b843134d-45c7-4cfa-9e6c-e4a53917459e
Thoresen, Marianne
57b47331-370d-49e9-9cd5-1055d50c8f39
CoolCap Study Group
Gunn, Alistair J.
86d02028-3434-440d-8eae-f9c97938ee47
Wyatt, John S.
e0f73250-efa3-4bb6-adf6-ab0c92432ccb
Whitelaw, Andrew
eb4fbfaf-e060-46de-98ca-28ccdf551a1e
Barks, John
5928f8c7-0fa9-4482-b286-29eca51ae5c1
Azzopardi, Denis
1518088a-ed90-4a76-ac3b-274fef8cbeed
Ballard, Roberta
7f6967bd-7e19-40ee-aebf-73ec6a85742f
Edwards, A. David
221ff1ff-ee2c-4c16-b72e-5e84071dab29
Ferriero, Donna M.
e25ad321-9c72-45f2-9f94-3886d8faefcb
Gluckman, Peter D.
ef2e8b92-0b76-4a12-bd7c-01b0674f94d3
Polin, Richard A.
24811542-b299-4098-903c-8d405075e023
Robertson, Charlene M.
b843134d-45c7-4cfa-9e6c-e4a53917459e
Thoresen, Marianne
57b47331-370d-49e9-9cd5-1055d50c8f39

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)

Record type: Article

Abstract

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.

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Published date: January 2008

Identifiers

Local EPrints ID: 61187
URI: http://eprints.soton.ac.uk/id/eprint/61187
ISSN: 0022-3476
PURE UUID: 4d6ee5dd-899c-46e0-b119-8ea649c80709

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Date deposited: 09 Oct 2008
Last modified: 15 Mar 2024 11:25

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Contributors

Author: Alistair J. Gunn
Author: John S. Wyatt
Author: Andrew Whitelaw
Author: John Barks
Author: Denis Azzopardi
Author: Roberta Ballard
Author: A. David Edwards
Author: Donna M. Ferriero
Author: Peter D. Gluckman
Author: Richard A. Polin
Author: Charlene M. Robertson
Author: Marianne Thoresen
Corporate Author: CoolCap Study Group

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