title: Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study.
abstract: OBJECTIVE
  Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that therapeutic hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns.
  
  
  METHODS
  Retrospective study, conducted in a university hospital.
  
  
  METHODS
  Thirty-five patients with perinatal asphyxia undergoing body cooling between May 2009 and November 2012 were evaluated.
  
  
  RESULTS
  Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The main complication was infection, diagnosed in seven mothers (20%) and 14 newborns (40%). Convulsions occurred in 15 infants (43%). Thirty-one patients (88.6%) required mechanical ventilation and 14 of them (45%) were extubated within 24 hours. The duration of mechanical ventilation among the others was 7.7 days. The cooling protocol was started 1.8 hours after birth. All patients showed elevated levels of creatine phosphokinase, creatine phosphokinase- MB and lactate dehydrogenase. There was no severe arrhythmia; one newborn (2.9%) presented controlled coagulopathy. Four patients (11.4%) presented controlled hypotension. Twenty-nine patients (82.9%) underwent cerebral ultrasonography and 10 of them (34.5%) presented white matter hyper-echogenicity. Brain magnetic resonance imaging was performed on 33 infants (94.3%) and 11 of them (33.3%) presented hypoxic-ischemic changes. The hospital stay was 23 days. All newborns were discharged. Two patients (5.8%) needed gastrostomy.
  
  
  CONCLUSIONS
  Hypothermia as therapy for asphyxiated newborns was shown to be safe.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Magalhães
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Francisco Paulo Martins
authors.initials: FP
authors.lastname: Rodrigues
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Maria Renata Tollio
authors.initials: MR
authors.lastname: Chopard
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Victoria Catarina de Albuquerque
authors.initials: VC
authors.lastname: Melo
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Amanda
authors.initials: A
authors.lastname: Melhado
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Inez
authors.initials: I
authors.lastname: Oliveira
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Clery Bernardi
authors.initials: CB
authors.lastname: Gallacci
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Pachi
authors.affiliation: Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Tabajara Barbosa
authors.initials: TB
authors.lastname: Lima Neto
mesh_terms: D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000628:therapy*; D001938:Brazil; D003402:Creatine Kinase / Q000097:blood; D003428:Cross Infection / Q000150:complications; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D007231:Infant, Newborn; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014463:Ultrasonography
chemical_list: D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase