To Study the Clinical Profile and Short-Term Outcomes of Whole-Body Therapeutic Hypothermia in Patients of Hypoxic Ischemic Encephalopathy
Abstract
Background: Neonatal encephalopathy (NE) is the clinical syndrome of disordered neurological function, and hypoxic ischemic encephalopathy (HIE) is NE that follows a perinatal hypoxic ischemic event. Strict criteria for making this diagnosis are constantly being developed but the essential components are the development of encephalopathy in a term/near term neonate soon after birth following an intrapartum event likely to cause hypoxia-ischemia. Aim: To study the clinical profile and short-term outcomes of whole-body therapeutic hypothermia in patients of hypoxic ischemic encephalopathy. Method: It was a prospective observational study conducted in a level IIIA NICU in Shri Shishu Bhawan Hospital, Bilaspur which is a tertiary care hospital from April – 2022 to March – 2023. It included all the newborn patients admitted with birth asphyxia with convulsions. Epidemiological data was collected, and patients were monitored for other complications. APGAR scores were recorded and Modified Sarnat and Sarnat staging was used to categorize HIE. Data was analyzed through SPSSv30. Results: Out of 12 neonates with birth weight <2.5 kg, 10 (83.33%) neonates were discharged and 2 (16.67%) neonates died while out of 51 neonates with birth weight >2.5 kg, 34 (66.67%) neonates were discharged and 17 (33.33%) neonates died. Results also show mortality in low birth is less than birth weight >2.5 kg. Our study shows outcome is better and low death occur when therapeutic hypothermia starts before 6hrs as compared to initiated after 6hrs. This may be due to early start of therapy leads to early reversal of pathology, early resuscitations and supportive treatment. Conclusion: Therapeutic hypothermia initiated before 6hrs had lesser complication like seizures, persistent acidosis, cardiac arrhythmia, hypotension, hypoglycemia and oliguria compared to initiate after 6hrs this may be due to early reversal of pathology during the first stage which is primary neuronal death and taking benefits of the latent period between primary and delayed neuronal death which is approximately 6 hours. Also, outcomes better if initiation of cooling is within 6hrs compared to after 6hrs mostly due to taking benefits of the latent period between primary and delayed neuronal death which is approximately 6 hours.Keywords:
Encephalopathy, Hypoxic Ischemic Encephalopathy, Therapeutic Hypothermia, NeonatalReferences
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