Division of Neonatal-Perinatal Medicine, College of Medicine, University of Vermont College of Medicine, Burlington, VT 05401, USA.
J Perinatol. 2010 Oct;30 Suppl:S82-7. doi: 10.1038/jp.2010.91.
Neonatal encephalopathy affects 2 to 5 of every 1000 live births and represents a major cause of mortality and long-term morbidity in affected infants. Hypoxic ischemic encephalopathy (HIE) is the major cause of encephalopathy in the neonatal period. Until recently, management of a newborn with encephalopathy has consisted largely of supportive care to restore and maintain cerebral perfusion, provide adequate gas exchange and treat seizure activity. Recent randomized controlled trials have shown that mild therapeutic hypothermia (cooling) initiated within 6 h of birth reduces death and disability in these infants. Cooling can be accomplished through whole-body cooling or selective head cooling. Meta-analysis of these trials suggests that for every six or seven infants with moderate to severe HIE who are treated with mild hypothermia, there will be one fewer infant who dies or has significant neurodevelopmental disability. In response to this evidence, major policy makers and guideline developers have recommended that cooling therapy be offered to infants with moderate to severe HIE. The dissemination of this new therapy will require improved identification of infants with HIE and regional commitment to allow these infants to be cared for in a timely manner.
新生儿脑病影响每 1000 例活产中的 2 至 5 例，是患病婴儿死亡和长期患病的主要原因。缺氧缺血性脑病（HIE）是新生儿期脑病的主要原因。直到最近，对脑病新生儿的治疗主要包括支持性护理，以恢复和维持脑灌注，提供充足的气体交换和治疗癫痫发作。最近的随机对照试验表明，出生后 6 小时内开始轻度治疗性低温（冷却）可降低这些婴儿的死亡率和残疾率。冷却可以通过全身冷却或选择性头部冷却来实现。这些试验的荟萃分析表明，每治疗六或七个患有中重度 HIE 的婴儿，就会有一个婴儿的死亡或严重神经发育障碍的风险降低。针对这一证据，主要的决策者和指南制定者建议为患有中重度 HIE 的婴儿提供冷却治疗。这种新疗法的推广需要更好地识别患有 HIE 的婴儿，并在区域内承诺及时照顾这些婴儿。
