Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada.
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Neonatal Perinatal Med. 2020;13(4):449-458. doi: 10.3233/NPM-190368.
Birth asphyxia in term neonates remains a serious condition that causes significant mortality and long-term neurodevelopmental sequelae despite hypothermia treatment. The objective of this study was to review therapeutic hypothermia practices in a large population of neonates with hypoxic-ischemic encephalopathy (HIE) across Canada and to identify determinants of adverse outcome.
Our retrospective observational cohort study examined neonates≥36 weeks, admitted to the Canadian Neonatal Network NICUs between 2010 and 2014, diagnosed with HIE, and treated with hypothermia. Adverse outcome was defined as death and/or brain injury. Maternal, birth, and postnatal characteristics were compared between neonates with adverse outcome and those without. The association between the variables which were significantly different (p < 0.05) between the two groups and adverse outcome were further tested, while adjusting for gestational age, birth weight, gender, and initial severity of encephalopathy.
A total of 2187 neonates were admitted for HIE; 52% were treated with hypothermia and 40% developed adverse outcome. Initial severity of encephalopathy (moderate, p = 0.006; severe, p < 0.0001), hypotension treated with inotropes (p = 0.001), and renal failure (p = 0.007) were significantly associated with an increased risk of death and/or brain injury.
In asphyxiated neonates treated with hypothermia, not only their initial severity of encephalopathy on admission, but also their cardiac and renal complications during the first days after birth were significantly associated with risk of death and/or brain injury. Careful monitoring and cautious management of these complications is warranted.
尽管采用了低温治疗，足月新生儿的出生窒息仍然是一种严重的情况，会导致高死亡率和长期神经发育后遗症。本研究的目的是回顾加拿大大量患有缺氧缺血性脑病（HIE）的新生儿的低温治疗实践，并确定不良结局的决定因素。
我们的回顾性观察性队列研究检查了 2010 年至 2014 年间在加拿大新生儿网络 NICU 住院的胎龄≥36 周、诊断为 HIE 并接受低温治疗的新生儿。不良结局定义为死亡和/或脑损伤。将有不良结局的新生儿与无不良结局的新生儿的母亲、分娩和产后特征进行比较。进一步测试了两组之间有显著差异（p<0.05）的变量与不良结局之间的关系，同时调整了胎龄、出生体重、性别和初始脑病严重程度。
共有 2187 例新生儿因 HIE 住院；52%接受了低温治疗，40%发生了不良结局。初始脑病严重程度（中度，p=0.006；重度，p<0.0001）、用正性肌力药治疗低血压（p=0.001）和肾功能衰竭（p=0.007）与死亡和/或脑损伤风险增加显著相关。
在接受低温治疗的窒息新生儿中，不仅入院时的初始脑病严重程度，而且出生后最初几天的心脏和肾脏并发症与死亡和/或脑损伤的风险显著相关。需要仔细监测和谨慎处理这些并发症。
