Therapeutic hypothermia initiated after 6 hours of age and benefits in the treatment of hypoxic ischemic encephalopathy

Case presentation: Term newborn, born by cesarean section after 3 days of induction, with urgent interruption indicated due to unfavorable cardiotocography. At birth, the patient was hypotonic, without crying, was taken to a warm crib, suction of the airways was performed, with a large amount of meconium coming out. Performed 3 cycles of PPV (Positive Pressure Ventilation), proceeded with OTI (Orotracheal Intubation). Apgar ⅙. Referred to the Neonatal Intensive Care Unit (NICU). Tension pneumothorax was identified on the left, a relief puncture was performed, and a drain was left for drainage. He evolved with seizures in the first hours of life, with a loading dose of phenobarbital (20mg/kg/dose) and a maintenance dose (5mg/kg/dose). Evolved with distributive shock, requiring vasoactive drug. The SARNAT scale was applied, which showed moderate Hypoxic Ischemic Encephalopathy (EIH). Therefore, he was submitted to therapeutic hypothermia at 16 hours of life, with temperature maintained between 33.5°C and 34°C for 96 hours, with monitoring of vital signs and electroencephalographic monitoring. Evolved with improvement of seizures and neurological pattern observed daily through the SARNAT scale. It tolerated well the progression of the diet. Transfontanellar ultrasound and magnetic resonance imaging of the brain region were performed without alterations. After 21 days of hospitalization in a NICU bed, she was referred to the hemodynamically stable ward. Evolved with good acceptance of the oral diet. being discharged with multivitamins, phenobarbital 3mg/kg/dose and outpatient follow-up with neuropediatrics, general pediatrics and early stimulation.

Discussion: A randomized multicenter trial conducted at 21 centers of the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Neonatal Research Network located in the United States over 8 years in infants with moderate and severe HIE treated with hypothermia resulted in a 76% probability of reduction in death or disability. While the probability of death or disability was less than 2% lower in hypothermia compared with non-cold babies it was 64%. In this case report, we present two cases of newborns who presented neonatal asphyxia and who underwent late therapeutic hypothermia in the neonatal ICU of the Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, with good neurological evolution after the introduction of therapeutic hypothermia, although late.

Final comments: Protective late therapeutic hypotermia as an alternative.

 

MissingLinkText

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
18. September 2023