Newborns Referred for Therapeutic Hypothermia: Association between Initial Degree of Encephalopathy and Severity of Brain Injury (What About the Newborns with Mild Encephalopathy on Admission?).
OBJECTIVE
The aim of this article was to describe the severity of brain injury and/or mortality in a cohort of newborns referred for therapeutic hypothermia, in relation to the degree of encephalopathy on admission, and to especially look at the ones with initial mild encephalopathy.


METHODS
Term newborns with perinatal depression referred to our neonatal intensive care unit for possible hypothermia treatment from 2008 to 2012 were enrolled prospectively. The modified Sarnat score on admission was correlated with severity of brain injury on brain imaging and/or autopsy.


RESULTS
A total of 215 newborns were referred for possible cooling. Sixty percent (128/215) were cooled. Most of the not-cooled newborns with an available brain magnetic resonance imaging (85% = 50/59) had an initial mild encephalopathy, and 40% (20/50) developed brain injury. Some cooled newborns had an initial mild encephalopathy (12% = 13/108); only 31% (4/13) developed brain injury.


CONCLUSIONS
Our results demonstrated that several newborns with an initial mild encephalopathy developed subsequent brain injury, especially when they were not cooled.
Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
Maude
M
Gagne-Loranger
Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
Megan
M
Sheppard
Division of Newborn Medicine, Department of Pediatrics, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Canada.
Nabeel
N
Ali
Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Canada.
Christine
C
Saint-Martin
Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
Pia
P
Wintermark
D001238:Asphyxia Neonatorum / Q000150:complications / Q000628:therapy*; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation; D012720:Severity of Illness Index