Brandt Jennifer B, Steiner Sabine, Schlager Gerald, Sadeghi Kambis, Vargha Regina, Golej Johann, Hermon Michael
Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Department of Anaesthesiology, Intensive Care and Pain Therapy, Hospital of St. John of God, Vienna, Austria.
Acta Paediatr. 2021 Mar;110(3):805-810. doi: 10.1111/apa.15506. Epub 2020 Aug 12.
Since therapeutic hypothermia (TH) is known for its inhibitory effects on leucocyte migration and cytokine synthesis, our aim was to underline the necessity of early monitoring for potential immunomodulatory risks.
Using a 13-year retrospective case-control study at the paediatric intensive care unit (PICU) of the Medical University in Vienna, all newborn infants and children receiving TH were screened and compared with a diagnosis-matched control group undergoing conventional normothermic treatment (NT). TH was accomplished by using a non-invasive cooling device. Target temperature was 32-34°C. Children with evident infections, a medical history of an immunodeficiency or undergoing immunosuppressive therapy, were excluded.
During the observational period, 108 patients were screened, 27 of which underwent TH. Culture-proven infections occurred in 22% of the TH group compared with 4% of the normothermic controls (P = .1). From the second day following PICU admission, median C-reactive protein (CRP) values were higher in the TH group (day two P = .002, day three P = .0002, day six P = .008).
Children undergoing TH showed earlier and higher increases in CRP levels when compared to normothermic controls. These data underline the necessity of early and continuous monitoring for possible infectious complications.
鉴于治疗性低温（TH）对白细胞迁移和细胞因子合成具有抑制作用，我们的目的是强调早期监测潜在免疫调节风险的必要性。
在维也纳医科大学儿科重症监护病房（PICU）进行了一项为期13年的回顾性病例对照研究，对所有接受TH的新生儿和儿童进行筛查，并与接受传统常温治疗（NT）的诊断匹配对照组进行比较。TH通过使用无创冷却装置实现。目标温度为32-34°C。排除有明显感染、免疫缺陷病史或正在接受免疫抑制治疗的儿童。
在观察期内，共筛查了108例患者，其中27例接受了TH。TH组中经培养证实的感染发生率为22%，而常温对照组为4%（P = 0.1）。从入住PICU的第二天起，TH组的C反应蛋白（CRP）中位数水平更高（第二天P = 0.002，第三天P = 0.0002，第六天P = 0.008）。
与常温对照组相比，接受TH的儿童CRP水平升高更早且更高。这些数据强调了早期和持续监测可能的感染并发症的必要性。
