title: Safety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy.
abstract: To evaluate the safety and short-term outcomes of preterm neonates born at 34-35 weeks gestation with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia.
  
  
  
  Medical records of preterm neonates born at 34-35 weeks gestational age with HIE treated with therapeutic hypothermia were retrospectively reviewed. Short-term safety outcomes and the presence, severity (mild, moderate, severe), and patterns of brain injury on magnetic resonance imaging were reviewed using a standard scoring system, and compared with a cohort of term neonates with HIE treated with therapeutic hypothermia.
  
  
  
  Thirty-one preterm and 32 term neonates were identified. Therapeutic hypothermia-associated complications were seen in 90% of preterm infants and 81.3% of term infants (P = .30). In the preterm infants, hyperglycemia (58.1% vs31.3%, P = .03) and rewarming before completion of therapeutic hypothermia (19.4% vs 0.0%, P = .009) were more likely compared with term infants. All deaths occurred in the preterm group (12.9% vs 0%, P = .04). Neuroimaging showed the presence of injury in 80.6% of preterm infants and 59.4% of term infants (P = .07), with no differences in injury severity. Injury to the white matter was more prevalent in preterm infants compared with term infants (66.7% vs 25.0%, P = .001).
  
  
  
  Therapeutic hypothermia in infants born at 34-35 weeks gestational age appears feasible. Risks of mortality and side effects warrant caution with use of therapeutic hypothermia in preterm infants.
authors.affiliation: Division of Newborn-Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO. Electronic address: Rao_R@kids.wustl.edu.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Rao
authors.affiliation: Division of Newborn-Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO.
authors.forename: Shamik
authors.initials: S
authors.lastname: Trivedi
authors.affiliation: Division of Newborn-Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Vesoulis
authors.affiliation: Division of Newborn-Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Liao
authors.affiliation: Division of Pediatric Neurology, Departments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Smyser
authors.affiliation: Division of Newborn-Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Mathur
mesh_terms: D001034:Apgar Score; D015331:Cohort Studies; D016208:Databases, Factual; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D020925:Hypoxia-Ischemia, Brain / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D061214:Patient Safety; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: hypoxic-ischemic encephalopathy; magnetic resonance imaging; safety; therapeutic hypothermia; white matter injury