Lin Yu-Xin, Feng Xiao, Zhang Yi-Dan, Hong Wan-Rong, Zhao Hong-Ying
Department of Pediatrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2023 Apr 15;25(4):350-356. doi: 10.7499/j.issn.1008-8830.2211158.
To investigate the clinical efficacy of mild therapeutic hypothermia (MTH) with different rewarming time on neonatal hypoxic-ischemic encephalopathy (HIE).
A prospective study was performed on 101 neonates with HIE who were born and received MTH in Zhongshan Hospital, Xiamen University, from January 2018 to January 2022. These neonates were randomly divided into two groups: MTH1 group (=50; rewarming for 10 hours at a rate of 0.25°C/h) and MTH2 group (=51; rewarming for 25 hours at a rate of 0.10°C/h). The clinical features and the clinical efficacy were compared between the two groups. A binary logistic regression analysis was used to identify the factors influencing the occurrence of normal sleep-wake cycle (SWC) on amplitude-integrated electroencephalogram (aEEG) at 25 hours of rewarming.
There were no significant differences between the MTH1 and MTH2 groups in gestational age, 5-minute Apgar score, and proportion of neonates with moderate/severe HIE (>0.05). Compared with the MTH2 group, the MTH1 group tended to have a normal arterial blood pH value at the end of rewarming, a significantly shorter duration of oxygen dependence, a significantly higher proportion of neonates with normal SWC on aEEG at 10 and 25 hours of rewarming, and a significantly higher Neonatal Behavioral Neurological Assessment score on days 5, 12, and 28 after birth (<0.05), while there was no significant difference in the incidence rate of rewarming-related seizures between the two groups (>0.05). There were no significant differences between the two groups in the incidence rate of neurological disability at 6 months of age and the score of Bayley Scale of Infant Development at 3 and 6 months of age (>0.05). The binary logistic regression analysis showed that prolonged rewarming time (25 hours) was not conducive to the occurrence of normal SWC (=3.423, 95%: 1.237-9.469, =0.018).
Rewarming for 10 hours has a better short-term clinical efficacy than rewarming for 25 hours. Prolonging rewarming time has limited clinical benefits on neonates with moderate/severe HIE and is not conducive to the occurrence of normal SWC, and therefore, it is not recommended as a routine treatment method.
探讨不同复温时间的轻度治疗性低温(MTH)对新生儿缺氧缺血性脑病(HIE)的临床疗效。
对2018年1月至2022年1月在厦门大学附属中山医院出生并接受MTH治疗的101例HIE新生儿进行前瞻性研究。将这些新生儿随机分为两组:MTH1组(n = 50;以0.25°C/h的速度复温10小时)和MTH2组(n = 51;以0.10°C/h的速度复温25小时)。比较两组的临床特征和临床疗效。采用二元逻辑回归分析确定复温25小时时影响振幅整合脑电图(aEEG)上正常睡眠-觉醒周期(SWC)发生的因素。
MTH1组和MTH2组在胎龄、5分钟Apgar评分以及中度/重度HIE新生儿比例方面无显著差异(>0.05)。与MTH2组相比,MTH1组在复温结束时动脉血pH值趋于正常,氧依赖持续时间显著缩短,复温10小时和25小时时aEEG上SWC正常的新生儿比例显著更高,出生后第5、12和28天的新生儿行为神经学评估评分显著更高(<0.05),而两组复温相关惊厥的发生率无显著差异(>0.05)。两组在6个月龄时神经残疾发生率以及3个月和6个月龄时贝利婴儿发育量表评分方面无显著差异(>0.05)。二元逻辑回归分析显示,延长复温时间(25小时)不利于正常SWC的发生(β = 3.423,95%CI:1.237 - 9.469,P = 0.018)。
复温10小时的短期临床疗效优于复温25小时。延长复温时间对中度/重度HIE新生儿的临床益处有限,且不利于正常SWC的发生,因此,不建议将其作为常规治疗方法。