Hypothermia of Some Benefit to Neonates With Encephalopathy

Lower death rates; nonsignificant drop in combined end point of death/IQ score <70 at age 6 to 7

WEDNESDAY, May 30 (HealthDay News) -- For infants with neonatal hypoxic-ischemic encephalopathy, undergoing whole-body hypothermia results in lower mortality rates as well as a nonsignificant reduction in the combined end point of death or an IQ score of less than 70 at age 6 to 7 years, compared with usual care, according to a study published in the May 31 issue of the New England Journal of Medicine.

Seetha Shankaran, M.D., from Wayne State University in Detroit, and colleagues reviewed long-term outcomes of a randomized trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. Infants with moderate or severe encephalopathy were assigned to usual care (control group; 93 children) or whole-body cooling followed by slow rewarming (hypothermia group; 97 children). Cognitive, attention and executive, visuospatial, and neurologic function were evaluated, and physical and psychosocial health were assessed.

The researchers found that death or an IQ score below 70 occurred in 47 percent of children in the hypothermia group and 62 percent of those in the control group (P = 0.06); death occurred in 28 and 44 percent, respectively (P = 0.04), and death or severe disability occurred in 41 and 60 percent, respectively (P = 0.03). Moderate or severe disability occurred in 35 percent of 69 children in the hypothermia group and 38 percent of the 50 controls (P = 0.87). Attention-executive dysfunction occurred in 4 and 13 percent of the hypothermia and usual-care groups (P = 0.19), respectively, and visuospatial dysfunction occurred in 4 and 3 percent, respectively (P = 0.80).

"In summary, whole-body hypothermia did not significantly reduce the rate of a composite end point of death or an IQ score below 70 at 6 to 7 years of age," the authors write. "However, hypothermia resulted in lower death rates and did not increase rates of severe disability among survivors."

One author disclosed a financial relationship with MedImmune.

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