Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatr Res. 2019 Mar;85(4):442-448. doi: 10.1038/s41390-019-0291-1. Epub 2019 Jan 16.
Infants with moderate to severe neonatal encephalopathy (NE) benefit significantly from therapeutic hypothermia, with reduced risk of death or disability. However, the need for therapeutic hypothermia for infants with milder NE remains unclear. It has been suggested that these infants should not be offered therapeutic hypothermia as they may not be at risk for adverse neurodevelopmental outcome and that the balance of risk against potential benefit is unknown. Several key questions need to be answered including first, whether one can define NE in the first 6 h after birth so as to accurately distinguish infants with brain injury who may be at risk for adverse neurodevelopmental consequences. Second, will treatment of infants with mild NE with therapeutic hypothermia improve or even worsen neurological outcomes? Although alternate treatment protocols for mild NE may be feasible, the use of the current approach combined with rigorous avoidance of hyperthermia and initiation of hypothermia as early as possible after birth may promote optimal outcomes. Animal experimental data support the potential for greater benefit for mild HIE compared with moderate to severe HIE. This review will summarize current knowledge of mild NE and the challenges to a trial in this population.
患有中重度新生儿脑病 (NE) 的婴儿从治疗性低温治疗中显著获益，死亡或残疾风险降低。然而，对于轻度 NE 的婴儿是否需要治疗性低温治疗尚不清楚。有人认为，这些婴儿不应接受治疗性低温治疗，因为他们可能没有发生不良神经发育结局的风险，而且风险与潜在益处的平衡尚不清楚。需要回答几个关键问题，首先，是否可以在出生后 6 小时内定义 NE，以便准确区分可能存在不良神经发育后果风险的脑损伤婴儿。其次，治疗轻度 NE 的婴儿采用治疗性低温治疗是否会改善甚至恶化神经结局？尽管轻度 NE 的替代治疗方案可能是可行的，但采用目前的方法，严格避免发热，并在出生后尽早开始降温，可能会促进最佳结局。动物实验数据支持轻度 HIE 比中重度 HIE 可能有更大的获益。本文将总结目前对轻度 NE 的认识以及在该人群中开展试验的挑战。
