title: Cooling in the real world: therapeutic hypothermia in hypoxic-ischemic encephalopathy.
abstract: OBJECTIVE
  The benefits of therapeutic hypothermia have not been assessed from the perspective of the neurology clinic. We aimed to report the impact of the implementation of a local regional therapeutic hypothermia program on the neurodevelopmental outcomes of surviving hypoxic-ischemic encephalopathy (HIE) infants who were followed in the neonatal neurology clinic.
  
  
  METHODS
  Retrospective analysis of term infants referred to the neonatal neurology clinic after having been diagnosed with HIE and meeting eligibility criteria for therapeutic hypothermia between March 1999 and June 2010. Therapeutic hypothermia was implemented in September 2008. Outcome measures were dichotomously defined as: normal or adverse, which included cerebral palsy, global developmental delay, and epilepsy.
  
  
  RESULTS
  Thirty infants were included in the pre-therapeutic hypothermia group. Thirty-one infants received therapeutic hypothermia and 27 were adequately followed and included in the post-therapeutic hypothermia group. The frequency of an adverse outcome was significantly higher in the pre-therapeutic hypothermia infants (19/30 [63%] versus 4/27 [15%]; OR = 0.10; 95% CI, 0.03-0.37; P < 0.001). Neonatal clinical seizures were more frequent in the pre-therapeutic hypothermia group (P = 0.012). There were no differences regarding frequency of fetal distress, rate of caesarean sections, Apgar scores, need of resuscitation, cord/initial blood gases, and degrees of encephalopathy between the two groups.
  
  
  CONCLUSIONS
  The implementation of a regional therapeutic hypothermia program in our institution has vastly reduced the observed neurological morbidity of surviving HIE infants followed in our neonatal neurology clinic. A similar change in outcomes of infants with HIE can be anticipated by other centers and other clinics adopting this therapy.
authors.affiliation: Department of Neurology/Neurosurgery, McGill University, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Jarred
authors.initials: J
authors.lastname: Garfinkle
authors.forename: Guilherme Mendes
authors.initials: GM
authors.lastname: Sant'Anna
authors.forename: Pia
authors.initials: P
authors.lastname: Wintermark
authors.forename: Nabeel
authors.initials: N
authors.lastname: Ali
authors.forename: Linda
authors.initials: L
authors.lastname: Morneault
authors.forename: Louise
authors.initials: L
authors.lastname: Koclas
authors.forename: Michael I
authors.initials: MI
authors.lastname: Shevell
mesh_terms: D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Hypothermia; Hypoxic-ischemic encephalopathy; Neonatal; Neurological outcome