Herrera Tamara I, Edwards Laura, Malcolm William F, Smith P Brian, Fisher Kimberley A, Pizoli Carolyn, Gustafson Kathryn E, Goldstein Ricki F, Cotten C Michael, Goldberg Ronald N, Bidegain Margarita
Servicio de Recién Nacidos del Centro Hospitalario Pereira Rossell, Montevideo, Uruguay.
Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America.
Early Hum Dev. 2018 Oct;125:1-7. doi: 10.1016/j.earlhumdev.2018.08.003. Epub 2018 Aug 23.
Therapeutic hypothermia reduces the risk of death, or moderate to severe neurodevelopmental impairment (NDI) in term infants with hypoxic-ischemic encephalopathy (HIE). Reports of its safety and efficacy in preterm infants are scarce.
Report short and long-term outcomes of preterm infants with HIE who received therapeutic hypothermia.
A retrospective cohort analysis of all preterm infants <36 weeks' gestation with HIE who received whole body hypothermia in a single center from January 2007 to April 2015. The primary outcome was death or moderate to severe NDI defined by moderate or severe cerebral palsy, severe hearing or visual impairment, or cognitive score < 85 on the Bayley Scales of Infant Development III (BSID III) at 18-24 months' adjusted age.
30 infants with a median gestational age and birthweight of 35 weeks' (range; 33-35) and 2575 g (1850-4840) and a median first postnatal blood pH of 6.81 (6.58-7.14). Complications included coagulopathy (50%), early clinical seizures (43.3%), arterial hypotension (40%), persistent metabolic acidosis (37%) and thrombocytopenia (20%). Four infants died before or soon after discharge (18.2%). Eighteen surviving infants (69.2%) had follow up data; 7 of them had moderate to severe NDI (38.9%). Cognitive, motor and language mean composite BSID III scores were 84 (54-110), 83 (46-118), and 78 (46-112). Death or moderate to severe NDI occurred in 11/22 (50%) infants with known outcomes.
Large randomized trials on efficacy and safety are needed in this highly vulnerable population as the incidence of complications and the combined outcome of death and NDI is concerning.
治疗性低温可降低足月缺氧缺血性脑病（HIE）患儿的死亡风险或中重度神经发育障碍（NDI）风险。关于其在早产儿中的安全性和有效性的报道较少。
报告接受治疗性低温的HIE早产儿的短期和长期结局。
对2007年1月至2015年4月在单一中心接受全身低温治疗的所有孕周<36周的HIE早产儿进行回顾性队列分析。主要结局为在矫正年龄18 - 24个月时死亡或中重度NDI，定义为中度或重度脑瘫、严重听力或视力障碍，或贝利婴幼儿发展量表第三版（BSID III）认知得分<85分。
30例婴儿，中位孕周和出生体重分别为35周（范围：33 - 35周）和2575 g（1850 - 4840 g），出生后首次血液pH值中位数为6.81（6.58 - 7.14）。并发症包括凝血功能障碍（50%）、早期临床惊厥（43.3%）、动脉低血压（40%）、持续性代谢性酸中毒（37%）和血小板减少症（20%）。4例婴儿在出院前或出院后不久死亡（18.2%）。18例存活婴儿（69.2%）有随访数据；其中7例有中重度NDI（38.9%）。认知、运动和语言BSID III平均综合得分分别为84（54 - 110）、83（46 - 118）和78（46 - 112）。在有已知结局的22例婴儿中，11例（50%）发生死亡或中重度NDI。
由于并发症发生率以及死亡和NDI的综合结局令人担忧，在这个高度脆弱的人群中需要进行大规模的疗效和安全性随机试验。
