Hypothermia for neonatal encephalopathy: Outcomes at, 6-7years

摘要

A USA multicentre study reported in 2005 showed that 72 h of whole-body hypothermia at 33.5° beginning within 6 h of birth improved outcomes at 18-24 months for infants with moderate or severe hypoxia-ischaemic encephalopathy. The rate of death or moderate or severe subsequent disability was reduced from 62% in controls to 44% in the hypothermia group. The rate of moderate or severe cerebral palsy in survivors was reduced from 30% to 19%, of blindness from 14% to 7%, and of hearing impairment from 6% to 4%. Now (Seetha Shankaran and colleagues. N EnglJ Med 2012;366:2085-92) the 6-7 year outcomes have been reported. The analysis includes 97 children in the hypothermia group and 93 in the control group. The composite outcome of death or IQ<70 occurred in 47% (hypothermia) versus 62% (controls), (p=0.06). Death or severe disability occurred in 41% versus 60% (p=0.03), and death in 28% versus 44% (p=0.04). Among the 122 surviving children, moderate or severe disability occurred in similar proportions (31% vs 38%) in the two groups. Attention- executive dysfunction occurred in 4% versus 13% (p=0.19) and visuospatial dysfunction in 4% vs 3% (p=0.80). The rates of cerebral palsy, blindness, hearing impairment, and seizures were not significantly different in the two groups. Hypothermia reduced mortality without increasing the frequency of severe disability in survivors.