e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 8 ( 2 0 1 4 ) 3 9 1 e3 9 8
Official Journal of the European Paediatric Neurology Society
Original article
Outcomes of hypoxic ischaemic encephalopathy treated with therapeutic hypothermia using cool gel packs e Experience from Western Australia Jackie Gardiner a, Deepika Wagh a,c, Judy McMichael a,b, Mohammed Hakeem a, Shripada Rao a,c,* a
Department of Neonatology, Princess Margaret Hospital, Perth, Australia State Child Development Centre, West Perth, Australia c Centre of Neonatal Research and Education, University of Western Australia, Perth, Australia b
article info
abstract
Article history:
Therapeutic hypothermia is the standard clinical practice for neonates with moderate to
Received 18 March 2013
severe hypoxic ischaemic encephalopathy (HIE).
Received in revised form
Aim: To describe the two year neurodevelopmental outcomes of neonates who were
25 November 2013
routinely cooled using cool gel packs for HIE in Western Australia.
Accepted 7 February 2014
Methods: Retrospective study. Cases were identified from the neonatal databases. Information was collected from chart review.
Keywords:
Results: 65 infants received therapeutic hypothermia, of which 13 had mild, 35 moderate
Hypoxic ischaemic encephalopathy
and 17 had severe HIE. There were no serious adverse effects attributable to cooling. All 13
Therapeutic hypothermia
infants with mild HIE survived, of whom developmental outcomes were available on nine;
Neurodevelopmental outcomes
none had severe disability. Among 52 infants with moderate to severe HIE, there were nine deaths (17%) and developmental outcomes were available on 39; the incidence of severe disability was 23%. The risk of death or severe disability was 40% in infants with moderate to severe HIE. Physical growth was adequate at two years of age. Conclusions: Neonates undergoing therapeutic hypothermia with cool gel packs had both good survival rates and long term neurodevelopmental outcomes and met international benchmarks. Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. All rights reserved.
1.
Introduction
Moderate-to-severe hypoxic ischaemic encephalopathy (HIE) occurs at an approximate rate of 1e2 per 1000 live births1,2 and carries a high risk of mortality and long term disability.3e5
Systematic reviews of randomized trials have shown that therapeutic hypothermia decreases mortality and neurodevelopmental disability in infants with moderate to severe HIE.1,6e8 The fetal and newborn committee of the Canadian Pediatric Society recommends the use of whole body cooling (rectal temperature of 34 0.5 C) or selective head cooling
* Corresponding author. Neonatal Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia. Tel.: þ61 893408672; fax: þ61 893407858. E-mail address: [email protected] (S. Rao). 1090-3798/$ e see front matter Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. All rights reserved. http://dx.doi.org/10.1016/j.ejpn.2014.02.003
392
e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 8 ( 2 0 1 4 ) 3 9 1 e3 9 8
initiated as soon as possible within the first 6 h of life in infants with moderate HIE who are 36 weeks’ gestational age.9Our neonatal units have been offering therapeutic hypothermia since January 2008. We conducted this retrospective study to evaluate the long term outcomes of neonates who underwent therapeutic cooling for hypoxic ischaemic encephalopathy.
2.
Methods
2.1.
Patient population
All infants who underwent therapeutic hypothermia for HIE between 1st January 2008 and 30th June 2010 were identified from the neonatal database. Relevant information was obtained by reviewing the medical records of patients, the laboratory database and the neonatal follow up program database.
2.2.
Clinical protocol of cooling
The infants were eligible for cooling if they met the following criteria:1. 35 weeks gestational age 2.
Official Journal of the European Paediatric Neurology Society
Original article
Outcomes of hypoxic ischaemic encephalopathy treated with therapeutic hypothermia using cool gel packs e Experience from Western Australia Jackie Gardiner a, Deepika Wagh a,c, Judy McMichael a,b, Mohammed Hakeem a, Shripada Rao a,c,* a
Department of Neonatology, Princess Margaret Hospital, Perth, Australia State Child Development Centre, West Perth, Australia c Centre of Neonatal Research and Education, University of Western Australia, Perth, Australia b
article info
abstract
Article history:
Therapeutic hypothermia is the standard clinical practice for neonates with moderate to
Received 18 March 2013
severe hypoxic ischaemic encephalopathy (HIE).
Received in revised form
Aim: To describe the two year neurodevelopmental outcomes of neonates who were
25 November 2013
routinely cooled using cool gel packs for HIE in Western Australia.
Accepted 7 February 2014
Methods: Retrospective study. Cases were identified from the neonatal databases. Information was collected from chart review.
Keywords:
Results: 65 infants received therapeutic hypothermia, of which 13 had mild, 35 moderate
Hypoxic ischaemic encephalopathy
and 17 had severe HIE. There were no serious adverse effects attributable to cooling. All 13
Therapeutic hypothermia
infants with mild HIE survived, of whom developmental outcomes were available on nine;
Neurodevelopmental outcomes
none had severe disability. Among 52 infants with moderate to severe HIE, there were nine deaths (17%) and developmental outcomes were available on 39; the incidence of severe disability was 23%. The risk of death or severe disability was 40% in infants with moderate to severe HIE. Physical growth was adequate at two years of age. Conclusions: Neonates undergoing therapeutic hypothermia with cool gel packs had both good survival rates and long term neurodevelopmental outcomes and met international benchmarks. Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. All rights reserved.
1.
Introduction
Moderate-to-severe hypoxic ischaemic encephalopathy (HIE) occurs at an approximate rate of 1e2 per 1000 live births1,2 and carries a high risk of mortality and long term disability.3e5
Systematic reviews of randomized trials have shown that therapeutic hypothermia decreases mortality and neurodevelopmental disability in infants with moderate to severe HIE.1,6e8 The fetal and newborn committee of the Canadian Pediatric Society recommends the use of whole body cooling (rectal temperature of 34 0.5 C) or selective head cooling
* Corresponding author. Neonatal Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia. Tel.: þ61 893408672; fax: þ61 893407858. E-mail address: [email protected] (S. Rao). 1090-3798/$ e see front matter Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. All rights reserved. http://dx.doi.org/10.1016/j.ejpn.2014.02.003
392
e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 8 ( 2 0 1 4 ) 3 9 1 e3 9 8
initiated as soon as possible within the first 6 h of life in infants with moderate HIE who are 36 weeks’ gestational age.9Our neonatal units have been offering therapeutic hypothermia since January 2008. We conducted this retrospective study to evaluate the long term outcomes of neonates who underwent therapeutic cooling for hypoxic ischaemic encephalopathy.
2.
Methods
2.1.
Patient population
All infants who underwent therapeutic hypothermia for HIE between 1st January 2008 and 30th June 2010 were identified from the neonatal database. Relevant information was obtained by reviewing the medical records of patients, the laboratory database and the neonatal follow up program database.
2.2.
Clinical protocol of cooling
The infants were eligible for cooling if they met the following criteria:1. 35 weeks gestational age 2.
