Kinder- und Jugendmedizin 2010; 10(01): 16-20
DOI: 10.1055/s-0038-1628999
Neonatologie
Schattauer GmbH

Hypothermie in der Behandlung asphyktischer Neugeborener mit hypoxisch-ischämischer Enzephalopathie

Hypothermia as treatment for newborns with hypoxic-ischemic encephalopathy
M. Keller
1   Klinik für Kinderheilkunde I, Universitätsklinikum Essen
,
E. Griesmaier
2   Department Pädiatrie IV, Medizinische Universität Innsbruck
,
M. Timischl
2   Department Pädiatrie IV, Medizinische Universität Innsbruck
,
G. Simbruner
2   Department Pädiatrie IV, Medizinische Universität Innsbruck
› Author Affiliations
Further Information

Publication History

Eingegangen am: 15 June 2009

angenommen am: 26 June 2009

Publication Date:
25 January 2018 (online)

Zusammenfassung

Die hypoxisch-ischämische Enzephalopathie (HIE) als Folge der perinatalen Asphyxie ist ein Krankheitsbild mit einer hohen Mortalität und führt oft zu lebenslanger Morbidität. Bis in die letzten Jahre brachte die Forschung keinen durchschlagenden Erfolg in der Behandlung des neurologischen Schadens. Mit den Erkenntnissen über den genauen Pathomechanismus werden nun immer mehr neuroprotektive Strategien getestet. Unter diesen erbrachte bisher nur die Hypothermietherapie klinische Erfolge. Studien zeigten, dass vor allem Neugeborene mit moderater Enzephalopathie von der Hypothermietherapie profitieren. Dieser Artikel geht auf die Wirkungsweise der Hypothermie ein, gibt einen Überblick über die abgeschlossenen klinischen Studien und beschreibt die praktische Durchführung der Hypothermietherapie.

Summary

Perinatal hypoxic-ischemic encephalopathy (HIE) remains an important cause of neurologic disability. The current treatment for children with hypoxic-ischemic brain injury is still supportive. In the last years neuroprotective therapy has been tested in numerous animal models. Among these, for now only the treatment with hypothermia showed benefit in clinical studies. This review gives an overview of the pathomechanism and according to this the mechanisms of action of hypothermia. Furthermore completed clinical trials and the procedure of induced hypothermia are described.

 
  • Literatur

  • 1 al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics 1999; 103 6 Pt 1 1263-1271.
  • 2 Azzopardi D, Brocklehurst P, Edwards D. et al. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008; 8: 17.
  • 3 Blackmon LR, Stark AR. Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy. Pediatrics 2006; 117 (Suppl. 03) 942-948.
  • 4 Chan PH. Role of oxidants in ischemic brain damage. Stroke 1996; 27 (Suppl. 06) 1124-1129.
  • 5 Eicher DJ, Wagner CL, Katikaneni LP. et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32 (Suppl. 01) 11-17.
  • 6 Fukui O, Kinugasa Y, Fukuda A. et al. Post-ischemic hypothermia reduced IL-18 expression and suppressed microglial activation in the immature brain. Brain Res 2006; 1121 (Suppl. 01) 35-45.
  • 7 Gluckman PD, Wyatt JS, Azzopardi D. et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 9460 663-670.
  • 8 Gonzalez FF, Ferriero DM. Therapeutics for neonatal brain injury. Pharmacol Ther 2008; 120 (Suppl. 01) 43-53.
  • 9 Gunn AJ. Cerebral hypothermia for prevention of brain injury following perinatal asphyxia. Curr Opin Pediatr 2000; 12 (Suppl. 02) 111-115.
  • 10 Gunn AJ, Battin M, Gluckman PD. et al. Therapeutic hypothermia: from lab to NICU. J Perinat Med 2005; 33 (Suppl. 04) 340-346.
  • 11 Gunn AJ, Gluckman PD, Gunn TR. Selective head cooling in newborn infants after perinatal asphyxia: a safety study. Pediatrics 1998; 102 4 Pt 1 885-892.
  • 12 Jacobs S, Hunt R, Tarnow-Mordi W. et al. Cooling for newborns with hypoxic ischaemic encephalopathy.. Cochrane Database Syst Rev 2007; (Suppl. 04) CD003311.
  • 13 Osredkar D, Toet MC, van Rooij LG. et al. Sleep-wake cycling on amplitude-integrated electroencephalography in term newborns with hypoxicischemic encephalopathy. Pediatrics 2005; 115 (Suppl. 02) 327-332.
  • 14 Palisano R, Rosenbaum P, Walter S. et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (Suppl. 04) 214-223.
  • 15 Robertson CM, Finer NN, Grace MG. School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Pediatr 1989; 114 (Suppl. 05) 753-760.
  • 16 Shankaran S, Laptook AR. Hypothermia as a treatment for birth asphyxia. Clin Obstet Gynecol 2007; 50 (Suppl. 03) 624-635.
  • 17 Shankaran S, Laptook AR, Ehrenkranz RA. et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (Suppl. 15) 1574-1584.
  • 18 Shankaran S, Woldt E, Koepke T. et al. Acute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants. Early Hum Dev 1991; 25 (Suppl. 02) 135-148.
  • 19 Sirimanne ES, Blumberg RM, Bossano D. et al. The effect of prolonged modification of cerebral temperature on outcome after hypoxic-ischemic brain injury in the infant rat. Pediatr Res 1996; 39 4 Pt 1 591-597.
  • 20 Thompson CM, Puterman AS, Linley LL. et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr 1997; 86 (Suppl. 07) 757-761.
  • 21 Thoresen M. Cooling the newborn after asphyxia – physiological and experimental background and its clinical use. Semin Neonatol 2000; 5 (Suppl. 01) 61-73.
  • 22 Thoresen M, Whitelaw A. Cardiovascular changes during mild therapeutic hypothermia and rew-arming in infants with hypoxic-ischemic encephalopathy. Pediatrics 2000; 106 1 Pt 1 92-99.
  • 23 Traystman RJ, Kirsch JR, Koehler RC. Oxygen radical mechanisms of brain injury following ischemia and reperfusion. J Appl Physiol 1991; 71 (Suppl. 04) 1185-1195.
  • 24 Vannucci RC. Experimental biology of cerebral hypoxia-ischemia: relation to perinatal brain damage. Pediatr Res 1990; 27 4 Pt 1 317-326.
  • 25 Vannucci RC, Perlman JM. Interventions for peri-natal hypoxic-ischemic encephalopathy. Pediatrics 1997; 100 (Suppl. 06) 1004-1014.
  • 26 Yan Y, Dempsey RJ, Flemmer A. et al. Inhibition of Na(+)-K(+)-Cl(-) cotransporter during focal cerebral ischemia decreases edema and neuronal damage. Brain Res 2003; 961 (Suppl. 01) 22-31.
  • 27 Zhao W, Richardson JS, Mombourquette MJ. et al. Neuroprotective effects of hypothermia and U-78517F in cerebral ischemia are due to reducing oxygen-based free radicals: an electron paramagnetic resonance study with gerbils. J Neurosci Res 1996; 45 (Suppl. 03) 282-288.