neonatal therapeutic hypothermia

19 Feb

journal of pediatrics article commentary on hypothermia for neonatal encephalopathy

Not as prime-time as with adults, but there’s hypothermia being looked at for the tiny kiddos, too.

 

BOTTOM LINE CONCLUSION:

“Based on the available data and the significant knowledge gaps, the expert panel suggested that although hypothermia is unequivocally a promising therapy for HIE, a substantial proportion of infants still die or are left with disability despite treatment…”

 

For those interested, a quick hits look at the studies that article referenced:

study 1:

  • 218 infants
  • 73/110 (66%) conventional care died or had severe disability at 18 months
  • 59/108 (55%) assigned head cooling died or had severe disability at 18 months
  • (odds ratio 0.61; 95% CI 0.34-1.09, p=0.1).

study 2:

  • 205 infants.
  • Death or moderate or severe disability occurred in
    • 45 of 102 infants (44 percent) in the hypothermia group
    • 64 of 103 infants (62 percent) in the control group
  • (risk ratio, 0.72; 95 percent confidence interval, 0.54 to 0.95; P=0.01)

study 3:

  • 163 underwent intensive care with cooling, 162 underwent intensive care alone.
  • cooled group, 42 infants died and 32 survived but had severe neurodevelopmental disability,
  • noncooled group, 44 infants died and 42 had severe disability
  • (relative risk for either outcome, 0.86; 95% confidence interval [CI], 0.68 to 1.07; P=0.17)

study4:

  • 111 infants were evaluated at 18 to 21 months (53 in thehypothermia group and 58 in the normothermia group).
  • The rates of death or severe disability were
    • 51% in the hypothermia group
    • 83% in the normothermia group
  • (P=.001; odds ratio: 0.21 [95% confidence interval [CI]: 0.09-0.54]; number needed to treat: 4 [95% CI: 3-9])

study5:

  • 100 and 94 infants in the selective head cooling and control group, respectively
  • the combined outcome of death and severe disability
    • selective head cooling 31%
    • control groups 49%
  • (OR: 0.47; 95% CI: 0.26-0.84; P=.01)

study 6:

  • died or had a major sensorineural disability at 2 years
    • 55 of 107 infants (51.4%) in the hypothermia group
    • 67 of 101 infants (66.3%) in the control group
  • (risk ratio, 0.77 [95% confidence interval, 0.62-0.98]; P = .03).

 

Submitted by H. Reed-Day.

 

References: pediatrics article; referenced studies linked above; picture

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