Neurodevelopmental outcome following therapeutic hypothermia for perinatal asphyxia

Studies are supporting neuroprotective benefi t of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy. We assessed survival and neurodevelopmental outcome of neonates subjected to the procedure and factors that may have infl uenced it. Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxi al encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics. Twenty-fi ve children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the age of fi nal assessment, developmental cate gories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fimotor in 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all fi e categories, while three (15.8%) had abnormal results for all categories. None of the 18 parameters that were correlated with neurodevelopmental outcome showed statistical signifi cance. Amplitude integrated electroencephalography was done in ten patients and the most prominent fiwas discontinuous activity in eight patients. In conclusion, a relatively small number of patients and l imitations of this study design precluded any far-reaching conclusions, but we think that this method can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.