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Mild hypothermia treatment for neonatal hypoxic-ischemic encephalopathy (HIE)
1. What is neonatal hypoxic-ischemic encephalopathy ( HIE )?
Neonatal hypoxic-ischemic encephalopathy (HIE) refers to fetal or neonatal brain damage caused by partial or complete hypoxia, reduced or suspended cerebral blood flow caused by various perinatal asphyxias, and is a cause of neurological disability in children. (Cerebral palsy, mental retardation, etc.) One of the common causes.
Mild hypothermia therapy has become a routine treatment for neonatal HIE. A survey in 2021 showed that the implementation rate of mild hypothermia therapy for neonatal HIE in China is only 54%. Studies in the United Kingdom and Canada suggest the inclusion standards and implementation methods of mild hypothermia therapy in various medical institutions. There are also differences. Lets take a look at what the “Expert Consensus on Mild Hypothermia for the Treatment of Neonatal Hypoxic-Ischemic Encephalopathy (2022)” specifically says.
2. What is neonatal hypothermia treatment?
Mild hypothermia treatment for neonatal hypoxic ischemic encephalopathy (HIE) refers to the use of active cooling methods to reduce the body core temperature to 33.0~34.0°C, maintain it for 72 hours, and then slowly rewarm it to achieve Neuroprotective effects. An international multi-center large-sample study confirmed that mild hypothermia treatment of neonatal HIE can not only significantly reduce the mortality rate of children with HIE, but also reduce the incidence of adverse neurodevelopmental outcomes and cerebral palsy in survivors. The protective effect of mild hypothermia treatment during follow-up to preschool years still exists.
3. How to implement mild hypothermia treatment?
(1) Mild hypothermia equipment: It is first recommended to use temperature control equipment for mild hypothermia treatment. Simple hypothermia treatment is only used as an alternative treatment method when temperature control equipment is not available.
(2) Treatment time window: Children with HIE should start mild hypothermia treatment within 6 hours after birth. The earlier the start time, the better the neuroprotective effect.
(3) Treatment time: The mild hypothermia maintenance treatment time for neonatal HIE is 72 hours.
(4) Rewarming method: Slow rewarming should be adopted, with the rewarming speed ≤ 0.5 ℃/h and the rewarming time ≥ 5 h.
(5) Mild hypothermia during transportation: Mild hypothermia treatment should be carried out during transportation, with priority being given to active mild hypothermia treatment using temperature control equipment. The second best option is simple or passive mild hypothermia treatment.
4. Shurui Medical-Neonatal special temperature controller
(1) New generation of intelligent temperature controller
Shurui Medicals new generation intelligent temperature controller has an adaptive water temperature adjustment algorithm with temperature feedback control, which has better temperature control effect. The average cooling speed is faster during the induction period, the body temperature fluctuation is small during the maintenance period, and the rate during the rewarming period is controllable, reaching the maximum Optimized Targeted Body Temperature Management (TTM) therapy.
(2) Meet pre-hospital first aid and inter-hospital transfer
The device is small in size and light in weight. It has a lithium battery and can be mounted on a vehicle to meet the needs of equipment use in scenarios such as pre-hospital first aid and inter-hospital transfer.
5. Which children with HIE can be treated with mild hypothermia?
Inclusion criteria for mild hypothermia treatment:
(1) In international multi-center studies, children included in mild hypothermia therapy were born with a gestational age of ≥35 or 36 weeks. The weight inclusion criterion suitable for mild hypothermia treatment is birth weight ≥2000 g.
(2) Evidence of hypoxia and ischemia mainly includes four indicators: Apgar score, positive pressure ventilation time, umbilical cord blood or blood gas pH value within 1 hour after birth, and base remaining. The 10-minute Apgar score is <5 points, or the 5-minute Apgar score is <5 points; the positive pressure ventilation time is >10 minutes; most umbilical cord blood or arterial blood gas analyzes within 1 hour after birth require pH <7.0, and base remaining ≥ -16 mmol/L, or >12 mmol/L. The median Apgar score of children treated with hypothermia is 5 points, ranging from 3 to 7 points; the mean base remaining value is -17.1 mmol/L, ranging from -13 to -21 mmol. /L. The mild hypothermia treatment regimen for neonatal HIE formulated by some countries has also been adjusted to pH ≤ 7.10 and alkali surplus ≥ -12 mmol/L.
(3) It is currently believed that mild hypothermia treatment is mainly suitable for children with moderate to severe HIE.
6. Contraindications to mild hypothermia treatment:
(1) There are severe congenital malformations;
(2) Craniocerebral trauma or moderate or severe intracranial hemorrhage;
(3) Systemic congenital viral or bacterial infection;
(4) Clinically, there is a tendency for spontaneous bleeding or the platelet count is <50×109/L.
references:
[1] Neonatology Group of the Pediatric Branch of the Chinese Medical Association, Editorial Committee of the Chinese Journal of Pediatrics. Expert consensus on the treatment of mild hypothermia for neonatal hypoxic-ischemic encephalopathy (2022) [J]. Chinese Journal of Pediatrics, 2022, 60(10) :990-997.
