Abstract
Hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality in the neonatal population and neurological disability. The evidence shows that hypothermia therapy is capable of impacting these outcomes. This study was carried out with the objective of describing the clinical characteristics and the diagnostic aids made to newborns with HIE undergoing total body hypothermia therapy and the use of criteria for admission to therapy in a sample of two institutions in the city of Medellin.
METHODS:A descriptive retrospective study was conducted, including all patients with HIE admitted to hypothermia therapy during 2017 and 2018.
RESULTS:The data of 256 patients (males 182; 71.1 %) were obtained. There were flaws in the registry and subjectivity in the application of the entry criteria to the hypothermia protocol in both institutions. In 197 (77 %) patients there was no report of sentinel event and the prolonged labour was considered by the clinicians as a significant finding when defining the entrance to the therapy. There were also admitted patients who did not meet the criterion of APGAR ? 5 at 10 minutes (n = 136). The results suggest the need to improve adherence to the protocol for admission to therapy; but at the same time, it points out the importance of the clinician's concept when dealing with each patient individually.
References
Graham EM, Ruis KA, Hartman AL, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol. 2008;199(6):587-95.
Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thoresen M, et al. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr. 2008;8:17.
Ministerio de Salud. Guía de práctica clínica del recién nacido con asfixia perinatal. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IETS/GPC_Ptes_Asfix.pdf
Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Obstet Gynecol. 2014;123(4):896-901.
van Handel M, Swaab H, de Vries LS, Jongmans MJ. Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr. 2007;166(7):645-54.
Lemus-Varela ML, Sola A, Golombek SG, Baquero H, Dávila-Aliaga CR, Fariña D, et al. Recomendaciones terapéuticas del VII Consenso Clínico de SIBEN para la encefalopatía hipóxico-isquémica neonatal. NeoReviews. 2016;17(9):e554-7.
Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013(1):CD003311.
Edwards AD, Brocklehurst P, Gunn AJ, Halliday H, Juszczak E, Levene M, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ. 2010;340:c363.
Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012;166(6):558-66.
Kariholu U, Montaldo P, Markati T, Lally PJ, Pryce R, Teiserskas J, et al. Therapeutic hypothermia for mild neonatal encephalopathy: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2018. Dec 19. pii: fetalneonatal-2018-315711.
Shah PS, Ohlsson A, Perlman M. Hypothermia to treat neonatal hypoxic ischemic encephalopathy: systematic review. Arch Pediatr Adolesc Med. 2007;161(10):951-8.
Elshorbagy HH, Azab AA, Kamal NM, Barseem NF, Bassiouny MM, Elsayed MA, et al. Value of electroencephalographic monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. J Pediatr Neurosci. 2016;11(4):309-15.
Azzopardi D, Strohm B, Linsell L, Hobson A, Juszczak E, Kurinczuk JJ, et al. Implementation and conduct of therapeutic hypothermia for perinatal asphyxial encephalopathy in the UK--analysis of national data. PLoS One. 2012;7(6):e38504.
Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(8):692-700.
Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365(9460):663-70.
El-Dib M, Inder TE, Chalak LF, Massaro AN, Thoresen M, Gunn AJ. Should therapeutic hypothermia be offered to babies with mild neonatal encephalopathy in the first 6 h after birth? Pediatr Res. 2019;85(4):442-8.
Higgins RD, Shankaran S. Hypothermia for hypoxic ischemic encephalopathy in infants > or =36 weeks. Early Hum Dev. 2009;85(10 Suppl):S49-52.
American Academy of Pediatrics Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar Score. Pediatrics. 2015;136(4):819-22.
Martínez Biarge M. Morbilidad perinatal y neurológica asociada a los eventos centinela. Tesis doctoral: Universidad Autónoma de Madrid; 2008. Disponible en https://repositorio.uam.es/bitstream/handle/10486/6183/37603_mart%C3%ADnez_biarge_miriam.pdf ?sequence=1
Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ. 2010;340:c1471.
Sood BG, McLaughlin K, Cortez J. Near-infrared spectroscopy: applications in neonates. Semin Fetal Neonatal Med. 2015;20(3):164-72.
Garvey AA, Dempsey EM. Applications of near infrared spectroscopy in the neonate. Curr Opin Pediatr. 2018;30(2):209-15.
Hyttel-Sorensen S, Pellicer A, Alderliesten T, Austin T, van Bel F, Benders M, et al. Cerebral near infrared spectroscopy oximetry in extremely preterm infants: phase II randomised clinical trial. BMJ. 2015;350:g7635.
Alderliesten T, Dix L, Baerts W, Caicedo A, van Huffel S, Naulaers G, et al. Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates. Pediatr Res. 2016;79(1-1):55-64.
Peng S, Boudes E, Tan X, Saint-Martin C, Shevell M, Wintermark P. Does near-infrared spectroscopy identify asphyxiated newborns at risk of developing brain injury during hypothermia treatment? Am J Perinatol. 2015;32(6):555-64.
Chandrasekaran M, Chaban B, Montaldo P, Thayyil S. Predictive value of amplitude-integrated EEG (aEEG) after rescue hypothermic neuroprotection for hypoxic ischemic encephalopathy: a meta-analysis. J Perinatol. 2017;37(6):684-9.
Skranes JH, Lohaugen G, Schumacher EM, Osredkar D, Server A, Cowan FM, et al. Amplitude-integrated electroencephalography improves the identification of infants with encephalopathy for therapeutic hypothermia and predicts neurodevelopmental outcomes at 2 years of age. J Pediatr. 2017;187:34-42.
UPB. Agencia de Noticias Universidad Pontificia Bolivariana. 2019. Disponible en: www.upb.edu.co/es/noticias/clinica-universitaria-bolivariana-acreditada-en-salud-por-icontec
Hospital General de Medellín. Informe de gestión plan de desarrollo 2012-2015. Disponible en: www.hgm.gov.co/images/PDF/gestion-institucional/2016/informe-de-gestion-plan-de-desarrollo-2012-2015.pdf
DANE. Estadísticas nacimientos 2017. Disponible en www.dane.gov.co/index.php/estadisticas-por-tema/salud/nacimientos-y-defunciones/nacimientos/nacimientos-2017.
Londoño JL, Alvarado EJ, Casas JV, Rosselli D. Normas científicas, técnicas y administrativas para la investigación en salud. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
Gutiérrez MA, Uribe AF, Tabares CS. Sepsis and neonatal hypoxic ischemic encephalopathy. J Neurol Stroke. 2016;4(2):00124.
Namusoke H, Nannyonga MM, Ssebunya R, Nakibuuka VK, Mworozi E. Incidence and short term outcomes of neonates with hypoxic ischemic encephalopathy in a Peri Urban teaching hospital, Uganda: a prospective cohort study. Matern Health Neonatol Perinatol. 2018;4:6.
Parker SJ, Kuzniewicz M, Niki H, Wu YW. Antenatal and intrapartum risk factors for hypoxic-ischemic encephalopathy in a US birth cohort. J Pediatr. 2018;203:163-9.
Yang SH, Perez E, Cutright J, Liu R, He Z, Day AL, et al. Testosterone increases neurotoxicity of glutamate in vitro and ischemia-reperfusion injury in an animal model. J Appl Physiol (1985). 2002;92(1):195-201.
Muglia LJ, Katz M. The enigma of spontaneous preterm birth. N Engl J Med. 2010;362(6):529-35.
Jarvis S, Glinianaia SV, Arnaud C, Fauconnier J, Johnson A, McManus V, et al. Case gender and severity in cerebral palsy varies with intrauterine growth. Arch Dis Child. 2005;90(5):474-9.
Peelen MJ, Kazemier BM, Ravelli AC, De Groot CJ, Van Der Post JA, Mol BW, et al. Impact of fetal gender on the risk of preterm birth, a national cohort study. Acta Obstet Gynecol Scand. 2016;95(9):1034-41.
Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210(3):179-93.
Zuluaga RC, Serrano TC. Neonatal hypoxic-ischemic encephalopathy and hypothermia therapy: solving questions about monitoring and prognosis. Neonat Pediatr Med 2017;3:125.
Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S. Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. BMJ. 2018;360:k207.
Dalili H, Nili F, Sheikh M, Hardani AK, Shariat M, Nayeri F. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PLoS One. 2015;10(3):e0122116.
Ahearne CE, Boylan GB, Murray DM. Short and long term prognosis in perinatal asphyxia: An update. World J Clin Pediatr. 2016;5(1):67-74.
Kasdorf E, Laptook A, Azzopardi D, Jacobs S, Perlman JM. Improving infant outcome with a 10 min Apgar of 0. Arch Dis Child Fetal Neonatal Ed. 2015;100(2):F102-5.
Lie KK, Groholt EK, Eskild A. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. BMJ. 2010;341:c4990.
Papile LA. The Apgar score in the 21st century. N Engl J Med. 2001;344(7):519-20.
Prempunpong C, Efanov I, Sant'Anna G. Serum calcium concentrations and incidence of hypocalcemia in infants with moderate or severe hypoxic-ischemic encephalopathy: Effect of therapeutic hypothermia. Early Hum Dev. 2015;91(9):535-40.
Thakur J, Bhatta NK, Singh RR, Poudel P, Lamsal M, Shakya A. Prevalence of electrolyte disturbances in perinatal asphyxia: a prospective study. Ital J Pediatr. 2018;44(1):56.
DANE. Dirección de censos y demografía. Estadísticas vitales-EEV cifras definitivas año 2017. Disponible en: wrww.dane.govco/files/investigaciones/poblacion/cifras-definitivas-2017.pdf
Hayes BC, McGarvey C, Mulvany S, Kennedy J, Geary MP, Matthews TG, et al. A case-control study of hypoxic-ischemic encephalopathy in newborn infants at >36 weeks gestation. Am J Obstet Gynecol. 2013;209(1):29.e1-.e19.
Veerendra Mehar NA, Abhishek Agarwal, Dubey N, Kumawat H. Meconium-stained amniotic fluid as a potential risk factor for perinatal asphyxia: A single-center experience. J Clin Neonatol. 2016;5(3):157-61.
Miller SP, Weiss J, Barnwell A, Ferriero DM, Latal-Hajnal B, Ferrer-Rogers A, et al. Seizure-associated brain injury in term newborns with perinatal asphyxia. Neurology. 2002;58(4):542-8.
Silverstein FS. Do seizures contribute to neonatal hypoxic-ischemic brain injury? J Pediatr. 2009;155(3):305-6.
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