20 jan. gestacional com encefalopatia hipóxico-isquêmica. Desta forma, na recente atualização do programa de reanimação neonatal, há uma. A asfixia perinatal é uma condição aguda e freqüentemente imprevisíveis associado com encefalopatia hipóxico-isquêmica (HIE). O objetivo geral deste. O modelo de ratos pós-natal para hipóxico-isquêmica lesão cerebral é um modelo bem estabelecido de humanos encefalopatia hipóxico isquêmica neonatal.

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Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: A retrospective observational study.

Um estudo observacional retrospectivo. Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that hiplxico hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns. Thirty-five patients with perinatal asphyxia undergoing body cooling between May and November were ehcefalopatia.

Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The duration of mechanical ventilation among the others was 7. The cooling protocol was started 1. All patients showed elevated levels of creatine phosphokinase, creatine phosphokinase- MB and lactate dehydrogenase. There was no severe arrhythmia; one newborn 2.

Brain magnetic resonance imaging was performed on 33 infants Isquemicq hospital stay was 23 days. All newborns were discharged. Infant, newborn; Hypoxia, brain; Hypothermia; Asphyxia neonatorum; Magnetic resonance imaging. Trinta e cinco pacientes isqumica asfixia perinatal submetidos a resfriamento corporal entre maio de e novembro de foram avaliados.

A mediana do Apgar de 1 e 5 minutos foi de 2 e 5. Perinatal asphyxia consists of decreased metabolic and nutritional intake from mother to fetus, thereby causing low fetal tissue perfusion, hypoxia, hypercapnia and acidosis. neonatxl

O Modelo de encefalopatia hipóxico isquêmica Perinatal da Isquemia

One of its main consequences is hypoxic-ischemic encephalopathy HIEhipodico occurs in one to three cases per full-term newborns. The spectrum of long-term morbidity among survivors ranges from mild motor and cognitive deficits to cerebral palsy and severe cognitive deficits. Until recently, clinical HIE treatment consisted basically of neonatal intensive care support, correction of metabolic respiratory and hemodynamic disorders and use of anticonvulsants.

However, studies published over the last eight years have individually or collectively shown the effectiveness of using body hypothermia for HIE treatment, thereby promoting increased hipkxico without neurological sequelae, with lower morbidity and mortality.

Since the time of Hippocrates, therapeutic hypothermia has been applied to various clinical conditions. In a book written by Sir John Floyer, a physician and writer in the 17 th century, a procedure in which a stillborn infant was immersed in cold water to induce spontaneous breathing is described. Hypothermia reduces brain injury through its impact on several biological processes. It reduces vasogenic edema, hemorrhage and neutrophil infiltration.

It limits the release of excitatory neurotransmitters and the accumulation of intracellular calcium. The production of free radicals is restricted by hypothermia, and thus cells and organelles are protected from oxidative damage during reperfusion. Also, it reduces the activation of cytokine and neomatal cascades by increasing the concentration of interleukin, an anti-inflammatory cytokine, and reducing tumor necrosis factor-alpha.

Furthermore, hypothermia helps to maintain cerebral metabolism during and after cerebral attacks by decreasing the metabolic rate of glucose and oxygen. Through reducing caspase-3 activity and increasing the expression of the anti-apoptotic protein BCL-2, hypothermia limits neuronal apoptotic death.

Um Modelo de Leitão Neonatal encefalopatia hipóxico-isquêmica

Among newborns, this therapy consists of reducing body temperature by three to four degrees Celsius moderate hypothermiastarting within six hours of birth and continuing for 72 hours. The efficacy and safety of this treatment have ejcefalopatia confirmed in other studies and meta-analyses, and this has led to the introduction of hypothermia therapy protocols in daily clinical practice in many neonatal units worldwide.


Our aim in this study was therefore to issquemica on our experience of three years of hypothermia therapy on asphyxiated newborns in a tertiary hipoxkco hospital, demonstrating the characteristics of the newborn population undergoing this therapy, birth conditions, clinical complications, adverse effects, features of body temperature control and follow-up during the stay enceflopatia the neonatal unit.

This was a retrospective observational study on a cohort of newborns with HIE who fulfilled issquemica criteria for inclusion in a total body cooling protocol at a neonatology service in a tertiary-level university hospital Chart 1 and were treated between May and November The laboratory tests indicative of perinatal asphyxia comprised gas analysis pH and base excess, BE on samples collected from cord blood or from the newborn within the first hour of life and assays on the enzymes creatine phospho-kinase CPKcreatine phosphokinase-MB CK-MB and lactate dehydrogenase LDH collected from the infant before the sixth hour of life.

The possible adverse effects evaluated were cardiac arrhythmias, hypotension, coagulopathy, infection and death.

We performed the following imaging studies: We took into consideration changes osquemica the analyses that were consistent with hypoxic-ischemic injury.

We used the following assessments to determine the final outcome during the hospitalization period: For the statistical analysis, we firstly performed descriptive analysis on the data.

Qualitative variables were represented as absolute and relative frequencies. Numerical variables were expressed as mean, median, standard deviation SD and minimum and maximum values. In cases in which we found great variability in the samples, we encefalopatiia to use the median.

We used the chi-square encefaalopatia to compare qualitative variables and the non-parametric Kruskal-Wallis test to compare the Apgar variable. We used the Minitab statistical software. Thirty-nine infants met the criteria for inclusion in the hypothermia protocol during the study period.

Four of them had to be withdrawn from the study: The perinatal characteristics of the 35 patients studied are shown in Table 1. Nine pregnant women Five of these Among the other 17 infants, the duration of mechanical ventilation was 7. Body cooling began on average 1. The target temperature was attained, on average, 1. There was only one patient without enzyme samples.

The initial laboratory abnormalities are shown in Table 2. Considering the possible adverse effects resulting from hypothermia, no patient had any arrhythmia other than sinus bradycardia and only one patient 2. From March onwards, all the iequemica underwent MRI. The data relating to the hospital outcomes are reported in Table 3.


Cerebral ultrasonography was performed on 29 patients Brain MRI was performed on 33 infants, and 11 of them All the infants were discharged from the neonatal unit. Only two patients 5. This study reports on a three-year experience isquemlca administering hypothermia therapy to asphyxiated newborns in a tertiary-level university hospital.

The criteria for infant inclusion and exclusion were based on previous studies on safety. The gestational age for inclusion in the study more than 35 weeks made it possible to differentiate encephalopathy attributed to perinatal hypoxia from other problems relating to prematurity. In general, the efficacy of the neuroprotective effect diminishes if the cooling period starts after the therapeutic window, but evidence suggests that the neurological injury in HIE cases continues beyond this period.

The fact that no significant complications attributed to therapeutic hypothermia were observed, with successful maintenance of body temperature within 72 hours, shows hipozico this therapy is safe and easy to control and maintain when a multidisciplinary team is involved with the main aim of reducing neurological sequelae among infants with HIE. Regarding sedation, given that it is difficult to determine the degree of pain or discomfort in newborns with HIE isqumica undergo hypothermia, and that opioids appear to boost the neuroprotective effect of this therapy, we considered that it would be beneficial to use systematic sedation with low doses of opioids in this group of infants.

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All the patients with HIE who encrfalopatia hypothermia were kept fasting for 72 hours, in accordance with the protocols of previously published clinical trials.

This approach contributed towards the absence of gastrointestinal complications in our patients, as also seen in the results from the abovementioned studies. Although we used cold packs rather than thermal mattresses, we did not record any difficulties in maintaining the temperature within the established goals. Use of gel packs has been reported to reduce death or developmental neonatql at six months of age among infants with HIE, without increasing the adverse events, 19 although use of servo control systems can avoid temperature fluctuations.

We did not find any serious side effects or complications that were directly related to hypothermia. As in other studies, 9 — 14 we had cases of sinus bradycardia without hemodynamic effects. Cooling induces QTc prolongations in hypoxic full-term newborns that become normal with rewarming. Electrographic seizures are common and often nonconvulsive, and their onset occurs over a broad range of times within the enceralopatia days of life.

Encevalopatia changes found on brain US nwonatal not specific to HIE, but changes seen on MRI are more reliable, especially for demonstrating changes to the basal ganglia and thalamus.

The development and severity of motor deficits due to perinatal asphyxia correlate with the pattern of brain injury seen on MRI. MRI provides valuable prognostic information on hypothermia-treated infants.

However, we cannot rule out the hypothesis that hypothermia is an effective form of therapy for reducing neurological injuries. We succeeded in reducing the newborns’ body temperature, at the beginning of and during hypothermia therapy, and successfully performed rewarming.

We did not have any potentially serious complication relating to this therapy. The patients had favorable outcomes during the hospitalization period, given the high degree of neurological sequelae in this group of patients. In most infants with HIE, feeding impairments are present from the neonatal period onwards or started within the first six months.

It is necessary to follow this group of newborns clinically and neurologically, in order to better assess the results from this therapy. More studies involving hypothermia are needed, with longer exposure, lower temperatures and selective or whole-body hypothermia, and using other related therapies such as erythropoietin, xenon, melatonin, topiramate and stem cell therapy.

We concluded that the use of body hypothermia for neuroprotection among neonates with HIE within daily practice in our hospital did not lead to any problems when performed with a specific protocol and a trained multidisciplinary team.

Hypothermia as a form of therapy for asphyxiated newborns was shown to be safe. J Pediatr Rio J. Epidemiolology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Perlman M, Shah PS. Intrapartum risk factors for newborn encephalopathy: Cerebral hypothermia for prevention of brain injury following perinatal asphyxia.

Time for a cool head-neuroprotection becomes a reality. Origin and timing of brain lesions in term infants with neonatal encephalopathy.