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Determinants of outcomes after head cooling for neonatal encephalopathy

Determinants of outcomes after head cooling for neonatal encephalopathy
Determinants of outcomes after head cooling for neonatal encephalopathy
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
neonatal encephalopathy, hypoxic/ischemic encephalopathy, induced hypothermia, birth weight, pyrexia
0031-4005
912-921
Wyatt, John S.
e0f73250-efa3-4bb6-adf6-ab0c92432ccb
Gluckman, Peter D.
ef2e8b92-0b76-4a12-bd7c-01b0674f94d3
Liu, Ping Y.
cd043566-9b17-46d6-9eed-de8f426727b2
Azzopardi, Denis
1518088a-ed90-4a76-ac3b-274fef8cbeed
Ballard, Roberta
7f6967bd-7e19-40ee-aebf-73ec6a85742f
Edwards, A. David
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Ferriero, Donna M.
e25ad321-9c72-45f2-9f94-3886d8faefcb
Polin, Richard A.
24811542-b299-4098-903c-8d405075e023
Robertson, Charlene M.
b843134d-45c7-4cfa-9e6c-e4a53917459e
Thoresen, Marianne
57b47331-370d-49e9-9cd5-1055d50c8f39
Whitelaw, Andrew
eb4fbfaf-e060-46de-98ca-28ccdf551a1e
Gunn, Alistair J.
86d02028-3434-440d-8eae-f9c97938ee47
Wyatt, John S.
e0f73250-efa3-4bb6-adf6-ab0c92432ccb
Gluckman, Peter D.
ef2e8b92-0b76-4a12-bd7c-01b0674f94d3
Liu, Ping Y.
cd043566-9b17-46d6-9eed-de8f426727b2
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
Polin, Richard A.
24811542-b299-4098-903c-8d405075e023
Robertson, Charlene M.
b843134d-45c7-4cfa-9e6c-e4a53917459e
Thoresen, Marianne
57b47331-370d-49e9-9cd5-1055d50c8f39
Whitelaw, Andrew
eb4fbfaf-e060-46de-98ca-28ccdf551a1e
Gunn, Alistair J.
86d02028-3434-440d-8eae-f9c97938ee47

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).

Record type: Article

Abstract

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

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More information

Published date: 5 May 2007
Keywords: neonatal encephalopathy, hypoxic/ischemic encephalopathy, induced hypothermia, birth weight, pyrexia

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Local EPrints ID: 61618
URI: http://eprints.soton.ac.uk/id/eprint/61618
ISSN: 0031-4005
PURE UUID: 4f8e7d86-ec18-4ebd-b13b-9f1f37fee63f

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Date deposited: 08 Sep 2008
Last modified: 15 Mar 2024 11:27

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Contributors

Author: John S. Wyatt
Author: Peter D. Gluckman
Author: Ping Y. Liu
Author: Denis Azzopardi
Author: Roberta Ballard
Author: A. David Edwards
Author: Donna M. Ferriero
Author: Richard A. Polin
Author: Charlene M. Robertson
Author: Marianne Thoresen
Author: Andrew Whitelaw
Author: Alistair J. Gunn

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