Whole body cooling for treatment of and antecedents of neonatal encephalopathy: The Children's National Medical Center's experience May 2006–August 2009, –95 infants
Affiliations: Department of Neonatology, Children's National Medical Center, Washington, DC, USA | Department of Child Development, Children's National Medical Center, Washington, DC, USA | Department of Neurology, Children's National Medical Center, Washington, DC, USA
Note: [] Corresponding author: Stephen Baumgart, Department of Neonatology, Children's National Medical Center, West Wing 3, Suite 600, 111 Michigan Avenue, NW, Washington, DC 910010-2970, USA. Tel.: +1 202 476 5225; Fax: +1 202 476 3459; E-mail: [email protected]
Abstract: Therapeutic hypothermia has prevented death and brain injury after asphyxiation in 5 randomized trials. Objective: Demonstrate our therapeutic hypothermia program, and compare our results with these randomized trials. Design/Methods: Whole body cooling was performed in 95 infants gestation 36 wks and < 6 hrs of age with severe acidosis, perinatal complications, and/or CPR at birth. Infants were cooled to an esophageal temperature of 33.5°C for 72 hours, then re-warmed slowly. Results of clinical studies, adverse events, and hospital outcomes are reported. Results: 95 neonates (mean weight 3.43 ± 0.68 SD kg, gestation 39 ± 2 wks) were admitted at ages 4:31 ± 1:10 hrs. Umbilical cord pH ranged 6.43–7.36 (median 6.87). Perinatal sentinel events occurred in 51 subjects. 33/95 infants (35%) presented with clinical seizures; 74/95 infants (78%) are surviving; most are now seizure-free having had improvement of EEG during hypothermia; 19/95 (20%) had normal brain MRI, 52 (55%) had ischemic injuries. 63/74 survivors (85%) are home; 44/74 (60%) are fed orally and passed hearing screens. 30/74 (40%) require tube feedings, and/or have uncertain hearing. 11/74 (15%) were discharged to rehabilitation hospitals. 21 deaths occurred (21/95, 22%): 2 died suddenly on life support while cooling, with no response to CPR. 83% of survivors have been seen in followup; 53% have been seen at ≥9 months. Fifty percent of all followups seen have had normal neurodevelopmental exams. Conclusions: Hypothermia can be instituted safely with mortality and short term morbidity commensurate with 5 previous studies published or otherwise reported. Neurodevelopmental follow up continues.
