INFANT Research Centre, University College Cork, Cork, Ireland.
Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
Pediatr Res. 2024 Oct;96(5):1153-1161. doi: 10.1038/s41390-024-03184-6. Epub 2024 Apr 22.
Early induced therapeutic hypothermia represents the cornerstone treatment in neonates with probable hypoxic-ischemic encephalopathy. The selection of patients for treatment usually involves meeting criteria indicating evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. In this review, we highlight the variability that exists between some of the different regional and national eligibility guidelines. Determining the potential presence of perinatal hypoxia-ischemia may require either one, two or three signs amongst history of acute perinatal event, prolonged resuscitation at delivery, abnormal blood gases and low Apgar score, with a range of cutoff values. Clinical neurological exams often define the severity of encephalopathy differently, with varying number of domains required for determining eligibility and blurred interpretation of findings assigned to different severity grades in different systems. The role of early electrophysiological assessment is weighted differently. A clinical implication is that infants may receive different care depending on the location in which they are born. This could also impact epidemiological data, as inference of rates of moderate-severe encephalopathy based on therapeutic hypothermia rates are misleading and influenced by different eligibility methods used. We would advocate that a universally endorsed single severity staging of encephalopathy is vital for standardizing management and neonatal outcome. IMPACT: Variability exists between regional and national therapeutic hypothermia eligibility guidelines for neonates with probable hypoxic-ischemic encephalopathy. Differences are common in both criteria indicating perinatal hypoxia-ischemia and criteria defining moderate or severe encephalopathy. The role of early electrophysiological assessment is also weighted unequally. This reflects in different individual care and impacts research data. A universally endorsed single severity staging of encephalopathy would be crucial for standardizing management.
早期诱导性治疗性低温是患有可能缺氧缺血性脑病的新生儿的基础治疗方法。患者的选择通常涉及满足表明围产期缺氧缺血证据和中度或重度脑病存在的标准。在这篇综述中，我们强调了一些不同地区和国家资格指南之间存在的可变性。确定潜在的围产期缺氧缺血的存在可能需要在急性围产期事件的病史、分娩时长时间复苏、血气异常和低 Apgar 评分中出现一个、两个或三个迹象，并有一系列的截断值。临床神经检查通常以不同的方式定义脑病的严重程度，不同的系统中确定资格所需的域数量不同，对不同严重程度等级的发现的解释也模糊不清。早期电生理评估的作用也不同。临床意义是，婴儿可能会根据出生地点接受不同的护理。这也可能影响流行病学数据，因为基于治疗性低温的中度-重度脑病的发生率推断是有误导性的，并且受到使用的不同资格方法的影响。我们主张，普遍认可的单一严重程度的脑病分期对于标准化管理和新生儿结局至关重要。
患有可能缺氧缺血性脑病的新生儿的治疗性低温资格指南在地区和国家之间存在差异。在围产期缺氧缺血的标准和定义中度或重度脑病的标准中，差异很常见。早期电生理评估的作用也不均衡。这反映在不同的个体护理上，并影响研究数据。普遍认可的单一严重程度的脑病分期对于标准化管理至关重要。
