Gancia Paolo, Pomero Giulia
Neonatology-Neonatal Intensive Care Unit S. Croce and Carle Hospital, Cuneo, Italy.
J Matern Fetal Neonatal Med. 2011 Oct;24 Suppl 1:53-5. doi: 10.3109/14767058.2011.607617.
Therapeutic hypothermia (whole body or selective head cooling) is recognized as standard of care for brain injury control in term infants with perinatal hypoxic ischemic encephalopathy (HIE). Recent metanalyses and systematic reviews in human newborns have shown a reduction in mortality and long-term neurodevelopmental disability at 12-24 months of age, with more favourable effects in the less severe forms of HIE. HIE is most often noted in term newborns. Preterm infants can also suffer from HIE, but the clinical manifestations and pathology are different, involving subcortical gray matter injury in association with white matter damage. Several term and preterm animal experimental models showed that a reduction in brain temperature following a hypoxic-ischemic insult reduces energy expenditure and may reduce histological neuronal loss, but little is known on the safety of therapeutic hypothermia in preterm or very low birth weight (VLBW) infants. Hypothermia is one of the most promising future interventions for the treatment of acute ischemic stroke, and seems to improve survival and neurologic outcome after cardiac arrest in adults. Similarly, recent reviews have emphasized the possible role of therapeutic hypothermia after pediatric cardiac arrest, and a trial is ongoing to assess the benefits of induced hypothermia in pediatric traumatic brain injury. So far, there is a lack of data on other possible indications, i.e., neonates with stroke or after cardio-pulmonary resuscitation, and necrotizing enterocolitis. Carefully designed safety studies and large randomized trials for all the above conditions and especially for preterm infants should be planned.
治疗性低温（全身或选择性头部降温）被公认为是足月围产期缺氧缺血性脑病（HIE）患儿脑损伤控制的标准治疗方法。最近针对人类新生儿的荟萃分析和系统评价表明，12至24个月大时死亡率和长期神经发育残疾有所降低，对病情较轻的HIE患儿效果更佳。HIE最常见于足月新生儿。早产儿也可能患HIE，但临床表现和病理不同，涉及皮质下灰质损伤并伴有白质损害。多个足月和早产动物实验模型表明，缺氧缺血性损伤后脑部温度降低可减少能量消耗，并可能减少组织学上的神经元损失，但对于治疗性低温在早产儿或极低出生体重（VLBW）婴儿中的安全性知之甚少。低温是未来治疗急性缺血性中风最有前景的干预措施之一，似乎还能改善成人心脏骤停后的生存率和神经功能结局。同样，最近的综述强调了治疗性低温在小儿心脏骤停后的可能作用，一项评估诱导低温对小儿创伤性脑损伤益处的试验正在进行中。到目前为止，对于其他可能的适应症，即患有中风或心肺复苏后的新生儿以及坏死性小肠结肠炎，缺乏相关数据。应该针对上述所有情况，尤其是针对早产儿，精心设计安全性研究和大型随机试验。
