Elbahtiti A, Aly N Yehia, Abo-Lila R, Al-Sawan R
Department of Neonatology, Farwaniya Hospital, Ministry of Health, Kuwait city, Kuwait.
Department of Infection Control, Farwaniya Hospital, Ministry of Health, Kuwait city, Kuwait.
J Neonatal Perinatal Med. 2016 May 19;9(2):179-85. doi: 10.3233/NPM-16915090.
We aimed to evaluate the effect of therapeutic hypothermia (TH) on brain MRI findings, neurological outcome, and mortality in patients with perinatal hypoxic ischemic encephalopathy (HIE) and compare between two modalities of TH: whole body cooling (WBC) and selective head cooling (SHC).
Sixty-two inborn babies with HIE admitted to the NICU of a Kuwaiti teaching hospital between 2006 and 2013 were retrospectively reviewed. Patients were divided into two groups: group 1 (2006-2008, n = 30) never received hypothermia, and group 2 (2009-2013, n = 32) treated with hypothermia. Group 2 patients were chronologically divided into two subgroups: 2a, the SHC, (2009-2010, n = 15) and 2b, the WBC, (2011-2013, n = 17). Brain MRI taken 7-10 days after birth, neurological status and mortality at time of hospital discharge were evaluated.
Patients who received TH showed significantly fewer MRI hypoxic changes (P = 0.04) and had better neurological outcome. Their need for anticonvulsants diminished (P = 0.04). However, their need for inotropes and duration of mechanical ventilation were increased (P = 0.001 & 0.02 respectively). No significant difference in mortality was found between the two groups (P = 0.6). In regression analysis, only MRI hypoxic changes predicted the occurrence of neurological abnormalities (P = 0.001). No difference in brain MRI findings, neurological outcome and mortality was observed between subgroups 2a and 2b (P > 0.05).
TH improved the neurological outcome of HIE patients but had no effect on mortality. There was no difference between the two modalities of TH on patients' outcome.
我们旨在评估治疗性低温（TH）对围产期缺氧缺血性脑病（HIE）患者脑MRI表现、神经功能结局和死亡率的影响，并比较两种TH方式：全身降温（WBC）和选择性头部降温（SHC）。
回顾性分析2006年至2013年间入住科威特一家教学医院新生儿重症监护病房（NICU）的62例患有HIE的新生儿。患者分为两组：第1组（2006 - 2008年，n = 30）从未接受过低温治疗，第2组（2009 - 2013年，n = 32）接受过低温治疗。第2组患者按时间顺序分为两个亚组：2a组为选择性头部降温组（2009 - 2010年，n = 15），2b组为全身降温组（2011 - 2013年，n = 17）。评估出生后7 - 10天的脑MRI、出院时的神经状态和死亡率。
接受TH治疗的患者MRI缺氧改变明显较少（P = 0.04），神经功能结局更好。他们对抗惊厥药物的需求减少（P = 0.04）。然而，他们对血管活性药物的需求和机械通气时间增加（分别为P = 0.001和0.02）。两组之间死亡率无显著差异（P = 0.6）。在回归分析中，只有MRI缺氧改变可预测神经异常的发生（P = 0.001）。2a组和2b组在脑MRI表现、神经功能结局和死亡率方面未观察到差异（P > 0.05）。
TH改善了HIE患者的神经功能结局，但对死亡率无影响。两种TH方式对患者结局无差异。
