title: Time is brain: starting therapeutic hypothermia within three hours after birth improves motor outcome in asphyxiated newborns.
abstract: OBJECTIVE
  Therapeutic hypothermia (HT) is the standard treatment for newborns after perinatal asphyxia. Preclinical studies report that HT is more effective when started early.
  
  
  METHODS
  Eighty cooled newborns were analyzed and grouped according to when cooling was started after birth: early (≤180 min) or late (>181 min). For survivors we analyzed whether starting cooling early was associated with a better psychomotor or mental developmental index (PDI or MDI, Bayley Scales of Infant Development II) than late cooling.
  
  
  RESULTS
  Forty-three newborns started cooling early and 37 started late. There was no significant difference in the severity markers of perinatal asphyxia between the groups; however, nonsurvivors (n = 15) suffered more severe asphyxia and had significantly lower centiles for weight (BWC; p = 0.009). Of the 65 infants that survived, 35 were cooled early and 30 were cooled late. There was no difference in time to start cooling between those who survived and those who did not. For survivors, median PDI (IQR) was significantly higher when cooled early [90 (77-99)] compared to being cooled later [78 (70-90); p = 0.033]. There was no increase in cardiovascular adverse effects in those cooled early. There was no significant difference in MDI between early and late cooling [93 (77-103) vs. 89 (76-106), p = 0.594].
  
  
  CONCLUSIONS
  Starting cooling before 3 h of age in surviving asphyxiated newborns is safe and significantly improves motor outcome. Cooling should be initiated as soon as possible after birth in eligible infants.
authors.affiliation: Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, St. Michael's Hospital, Bristol, UK.
authors.forename: Marianne
authors.initials: M
authors.lastname: Thoresen
authors.forename: James
authors.initials: J
authors.lastname: Tooley
authors.forename: Xun
authors.initials: X
authors.lastname: Liu
authors.forename: Sally
authors.initials: S
authors.lastname: Jary
authors.forename: Peter
authors.initials: P
authors.lastname: Fleming
authors.forename: Karen
authors.initials: K
authors.lastname: Luyt
authors.forename: Anoopam
authors.initials: A
authors.lastname: Jain
authors.forename: Pamela
authors.initials: P
authors.lastname: Cairns
authors.forename: David
authors.initials: D
authors.lastname: Harding
authors.forename: Hemmen
authors.initials: H
authors.lastname: Sabir
mesh_terms: D001238:Asphyxia Neonatorum / Q000628:therapy*; D002657:Child Development / Q000502:physiology*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000592:standards; D007231:Infant, Newborn; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D018709:Statistics, Nonparametric; D013997:Time Factors