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THERAPEUTIC HYPOTHERMIA IN NEONATES: REVIEW OF CURRENT CLINICAL DATA, ILCOR RECOMMENDATIONS AND SUGGESTIONS FOR IMPLEMENTATION IN NEONATAL INTENSIVE CARE UNITS
  1. T Hoehn1,
  2. G Hansmann2,
  3. C Bührer3,
  4. G Simbruner4,
  5. A J Gunn5,
  6. J Yager6,
  7. M Levene7,
  8. S E G Hamrick8,
  9. S Shankaran9,
  10. M Thoresen10
  1. 1Neonatology And Pediatric Intensive Care Medicine, Department Of General Pediatrics, Heinrich-Heine-University, Duesseldorf, Germany
  2. 2Department Of Pediatrics, University Of California San Francisco, San Francisco, CA, USA
  3. 3Neonatologie, Universitäts-Kinderspital Beider Basel, Basel, Switzerland
  4. 4Department Of Neonatology, University Of Innsbruck, Innsbruck, Austria
  5. 5Departments Of Physiology And Paediatrics, University Of Auckland, Auckland, New Zealand
  6. 6Department Of Pediatrics, Stollery Children’s Hospital, University Of Alberta, Edmonton, AB, Canada
  7. 7Academic Department Of Paediatrics, University Of Leeds, Leeds, UK
  8. 8Department Of Pediatrics, Emory University, Atlanta, GA, USA
  9. 9Wayne State University School Of Medicine, Detroit, MI, USA
  10. 10Child Health At CSSB, University Of Bristol, Bristol, UK

Abstract

Recent evidence suggests that the current ILCOR guidelines regarding hypothermia for the treatment of neonatal encephalopathy need urgent revision. In 2005 when the current ILCOR guidelines were finalised one large (CoolCap trial, n = 235) and one small RCT (n = 67), in addition to pilot trials, had been published, and demonstrated that therapeutic hypothermia after perinatal asphyxia was safe. The CoolCap trial showed a borderline overall effect on death and disability at 18 months of age, but significant improvement in a large subset of infants with less severe electroencephalographic changes. Based on this and other available evidence, the 2005 ILCOR guidelines supported post resuscitation hypothermia in paediatric patients after cardiac arrest, but not after neonatal resuscitation. Subsequently, a whole body cooling trial supported by the NICHD reported a significant overall improvement in death or disability. Further large neonatal trials of hypothermia have stopped recruitment and their final results are likely to be published 2009–2011.

Many important questions around the optimal therapeutic use of hypothermia remain to be answered. Nevertheless, independent meta-analyses of the published trials now indicate a consistent, robust beneficial effect of therapeutic hypothermia for moderate to severe neonatal encephalopathy, with a mean NNT between 6 and 8. Given that there is currently no other clinically proven treatment for infants with neonatal encephalopathy we propose that an interim advisory statement should be issued to support and guide the introduction of therapeutic hypothermia into routine clinical practice.

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