DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20211674

Neurological assessment and immediate outcome of newborns treated with therapeutic hypothermia at tertiary care hospital of southern Rajasthan-a randomized control trial

Suresh Goyal, Anuradha Sanadhya, Juhi Mehrotra, Bhupesh Jain, Ritika Kachhwaha

Abstract


Background: Therapeutic hypothermia (TH) is standard-of-care for infants with moderate and severe HIE in developed countries; TH has been shown to decrease the risk of brain injury in asphyxiated newborns. Observations were like: 1) Asses morbidity and mortality in neonates with moderate and severe birth asphyxia treated with TH and 2) Asses neurological outcome in neonates.

Methods: A RCT was done in NICU of Balchikitsalaya, RNTMC, Udaipur. Phase changing material, FS 21, FS 29 used to provide TH for 72 hours, started within 6 hours of birth and neurological outcome was assessed.

Results: Total 60 neonates were enrolled 30 cases given TH and 30 control not given TH. Neurological assessment on basis of Thompson scoring, done on admission, 24, 48, 72 and 96 hours for both groups. At 48 hours, mean score in controls 14.5±1.67 and cases 11.47±2.34 (p<0.05). At discharge, mean score for controls was 11.31±3.67 and for cases was 5.24±2.72 (p<0.005). Mortality was 4 (13.3%) in cases and 11 (36.7%) in control group. Among 45 survivors, 25 (55.5%) required anticonvulsant at discharge; 15 from controls, 10 from cases group.

Conclusions: There was significant decrease in mortality in birth asphyxia babies given TH as compared to babies not given TH. Also, significant improvement in Thompson score among the cooled neonates at and after 48 hours of age suggestive of better immediate neurological outcome in these babies. Anticonvulsant’s requirement was also significantly less in therapeutic hypothermia group.


Keywords


Birth asphyxia, HIE, Therapeutics hypothermia, Thompson score

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References


Neonatal Mortality Rate (NMR), UN Inter-Agency Group for Child Mortality Estimation (UN IGME) Updated in 2019. Available from: http://data.unicef.org/topic/child-survival/neonatal-mortality. Accessed on 10 Jan, 2020.

Neo Natal Mortality Rate (NMR) (per 1000 live births) | NITI Aayog, Government of India. 2018. Available from: http://niti.gov.in/content/neo-natal-mortality-rate-nmr-1000-live-births. Accessed on 10 Jan, 2020.

Bhat BV, Adhishivam B. WHO Definition of Birth Asphyxia. Manual on Therapeutic Hypothermia For Perinatal Asphyxia, National Neonatology Forum. 2017;6.

Hansen AR, Soul JS. Perinatal Asphyxia and Hypoxic- Ischemic Encephalopathy. In Eric C, Eichenwald, Anne R. Hansen, Camilia R, Martin, Ann R, Stark (eds), Cloherty and Stark’s Manual of Neonatal Care. 8th ed, Wolters Kluwer. 2018;790-811.

Juul SE, Fleiss B, McAdams RM, Gressens P. Neuroprotection Strategies for the Newborn. In Christine A. Gleason C, Sandra E Juul (eds), Avery’s Diseases of Newborn, 10th ed, 1st South East Asia ed, Elsevier. 2019;910-21.

Bhat BV. Therapeutic Hypothermia Mechanisms of Action. In Bhat BV, B Adhishivam (eds), Manual on Therapeutic Hypothermia for Perinatal Asphyxia. National Neonatol Forum. 2017;11-3.

Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electro-encephalopathic study. Arch Neurol. 1976;33:696-705.

Thompson CM, Puterman AS, Linley LL, Hann FM, Van der Elst CW, Molteno CD et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr. 1997;86:675-786.

Thomas N, Abiramalatha T, Bhat V, Varanattu M, Rao S, Wazir S et al. Phase changing material for therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy-a multi-centric study. Indian Pediatr. 2018;55:201-5.

Thomas N, Chakrapani Y, Rebekah G, Kareti K, Devasahayam S. Phase Changing Material: An Alternative Method for Cooling Babies with Hypoxic Ischemic Encephalopathy. Neonatology. 2015;107:266-70.

Thomas N, George KC, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting: a feasibility trial. Indian Pediatr. 2011;48:445-51.

Shankaran S, Pappas A, Laptook AR, McDonald SA, Ehrenkranz RA, Tyson JE et al. Outcomes of safety and effectiveness in a multicenter randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatrics. 2008;122:791-8.

Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicenter randomized trial. Lancet. 2005.

Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. Moderate hypothermia to treat perinatal asphyxia encephalopathy. N Engl J Med. 2009;361:1349-58.

Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010;157:367-72.