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.
