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

Record type: Article

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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Citation

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), pp. 55-58. (doi:10.1016/j.jpeds.2007.06.003). (PMID:18154900).

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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: 17 Jul 2017 14:22

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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

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