Rutherford Mary A, Azzopardi Denis, Whitelaw Andrew, Cowan Frances, Renowden S, Edwards A David, Thoresen Marianne
Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, United Kingdom.
Pediatrics. 2005 Oct;116(4):1001-6. doi: 10.1542/peds.2005-0328.
Hypothermia induced by whole-body cooling (WBC) and selective head cooling (SHC) both reduce brain injury after hypoxia-ischemia in newborn animals, but it is not known how these treatments affect the incidence or pattern of brain injury in human newborns. To assess this, 14 term infants with hypoxic-ischemic encephalopathy (HIE) treated with SHC, 20 infants with HIE treated with WBC, and 52 noncooled infants with HIE of similar severity were studied with magnetic resonance imaging in the neonatal period. Infants fulfilling strict criteria for HIE were recruited into the study after assessment of an amplitude-integrated electroencephalography (aEEG). Cooling was commenced within 6 hours of birth and continued for 48 to 72 hours. Hypothermia was not associated with unexpected or unusual lesions, and the prevalence of intracranial hemorrhage was similar in all 3 groups. Both modes of hypothermia were associated with a decrease in basal ganglia and thalamic lesions, which are predictive of abnormal outcome. This decrease was significant in infants with a moderate aEEG finding but not in those with a severe aEEG finding. A decrease in the incidence of severe cortical lesions was seen in the infants treated with SHC.
全身冷却（WBC）和选择性头部冷却（SHC）诱导的低温均能减轻新生动物缺氧缺血后的脑损伤，但尚不清楚这些治疗方法如何影响人类新生儿脑损伤的发生率或模式。为了评估这一点，对14例接受SHC治疗的足月缺氧缺血性脑病（HIE）婴儿、20例接受WBC治疗的HIE婴儿以及52例病情严重程度相似的未接受冷却治疗的HIE婴儿在新生儿期进行了磁共振成像研究。在评估振幅整合脑电图（aEEG）后，将符合HIE严格标准的婴儿纳入研究。冷却在出生后6小时内开始，并持续48至72小时。低温与意外或异常病变无关，且所有3组颅内出血的发生率相似。两种低温模式均与基底神经节和丘脑病变减少有关，而这些病变可预测异常预后。这种减少在aEEG表现为中度的婴儿中显著，但在aEEG表现为重度的婴儿中不显著。接受SHC治疗的婴儿严重皮质病变的发生率有所降低。
