The Neonatal Unit, Queen Charlottes and Chelsea Hospital, London, UK.
Early Hum Dev. 2010 Jun;86(6):361-7. doi: 10.1016/j.earlhumdev.2010.05.013. Epub 2010 Jun 8.
There is now a strong evidence base supporting therapeutic hypothermia for infants with moderate or severe neonatal hypoxic ischaemic encephalopathy. Experimental and clinical data indicate that induced hypothermia reduces cerebral hypoxic ischaemic injury and randomized clinical trials in newborns with hypoxic ischaemic encephalopathy confirm improved neurological outcomes and survival at 18 months of age with therapeutic hypothermia. Studies are on-going to confirm whether these benefits are maintained in later childhood. Efforts are now focused on optimal implementation of therapeutic hypothermia in clinical practice: training in the assessment of severity of encephalopathy; initiation and maintenance of hypothermia before admission to a cooling facility; care of the infant during cooling; and appropriate investigation and follow-up are crucial for optimizing neurological outcomes. The establishment of registries of infants with hypoxic ischaemic encephalopathy and audit are important for guiding clinical practice.
目前有强有力的证据支持对中重度新生儿缺氧缺血性脑病的婴儿进行治疗性低温治疗。实验和临床数据表明，诱导性低温可减轻脑缺氧缺血性损伤，且新生儿缺氧缺血性脑病的随机临床试验证实，治疗性低温可改善 18 月龄时的神经发育结局和存活率。目前正在进行研究以确认这些益处是否在儿童后期持续存在。目前的工作重点是在临床实践中优化治疗性低温的实施：在进入冷却设施之前，对脑病严重程度进行评估的培训；开始和维持低温；在冷却过程中对婴儿的护理；以及进行适当的调查和随访对于优化神经发育结局至关重要。建立缺氧缺血性脑病婴儿的登记和审核制度对于指导临床实践非常重要。
