Clinical and Laboratory ObservationRandomized trial of systemic hypothermia selectively protects the cortex on MRI in term hypoxic-ischemic encephalopathy
Section snippets
Patients and methods
Between July 2001 and June 2003 our study recruited infants at least 35 weeks' gestational age with evidence of intrapartum hypoxia-ischemia comprising at least two of: (a) Apgar score of ≤5 at 10 minutes; (b) ongoing resuscitation in the form of mechanical ventilation at 10 minutes; and (c) metabolic acidosis (cord pH <7.00, or an arterial pH<7.00 or base deficit >12mmol/L or more within the first 60 minutes of life) combined with clinical evidence of encephalopathy. To facilitate recruitment
Results
Twenty-six infants had MRI at similar ages in both infant groups (mean ± SD hypothermia: 5.3 ± 2.9 days; nomothermia 6.3 ± 3.9 days). Only one infant had MRI at <4 days of age (hypothermia group), and one infant died prior to MRI. No infant had an alternative cause for the encephalopathy.
The infants had a mean (SD) gestational age of 38.7 (1.9) weeks and a mean birth weight of 3.55 (0.54) kg. There was no significant difference in gestational age or birth weight between the groups. Each group
Discussion
Our analysis of the MRI findings suggests that hypothermia may preferentially reduce cortical neuronal injury in the term infant with HIE. In contrast, there was no significant alteration in the incidence of basal ganglia abnormalities between the groups. The incidence of deep nuclear gray (DNG) matter injury in approximately 2 of 3 of infants with HIE is consistent with previously published data.6., 7. We are limited by the number of MRI studies to comment on the extent of injury within the
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Cited by (127)
Management of Hypoxic-Ischemic Encephalopathy Using Measures Other Than Therapeutic Hypothermia
2023, Principles of NeonatologyElectroencephalography and brain magnetic resonance imaging in asphyxia comparing cooled and non-cooled infants
2019, European Journal of Paediatric NeurologyCitation Excerpt :However compared to our study, conventional MRI scans were made after the first week of life, so there were no early MRI scans made combined with diffusion weighed imaging techniques. Our data revealed a preferential effect of HT on cortical regions, consistent with an earlier study.35 The 38% mortality rate among the cooled infants in the present study is slightly higher than those reported in the TOBY (26%) and CoolCap (33%) RCTs.
Neuroprotective agents for neonatal hypoxic-ischemic brain injury
2015, Drug Discovery Today
Supported by the Australian National Health and Medical Research Council (NHMRC Study No: 216725).