Therapeutic Hypothermia – Mechanism of action

Focusing on reducing in child mortality in the developing countries should be possible by establishing effective preventive and curative interventions that target the main causes of child deaths and the most vulnerable newborns and children. Continuous development in neonatal care and proliferation of new technologies allowed to significantly reduce neonatal mortality due to birth asphyxia and resulting in neonatal hypoxic-ischemic encephalopathy (HIE).

Therapeutic hypothermia, or whole body cooling, is one of the promising neuroprotective interventions and has become the standard of care in developed countries in treatment of moderate and severe HIE^4,5.

Did you know?

Inclusion and exclusion criteria need to be observed when inducing hypothermia. Please see the classifications criteria below under “Inclusion criteria” and “Exclusion criteria”:

Inclusion	Exclusion
Apgar score 5 or less at 10 minutes	>6 hours of birth (or later, at discretion of the attending neonatologist)
Need for mechanical ventilation or resuscitation at 10 min	Birth weight less than 2.0kg
Neonate with gestational age =>35 weeks	Life threatening coagulopathy
	Neonate with an imperforate anus if rectal probe to be used; not an exclusion if oesophageal probe can be used

Protocol for Therapeutic Hypothermia in Asphyxiated Neonates

Once the new borne is evaluated on the inclusion criteria for therapeutic hypothermia a standard protocol is applied.

During the initiation stage baby’s core temperature is cooled town to target temperature 33.5 ± 0.5º C within 6 hours after birth and maintained for 72 hours, followed by slow rewarming over 10-12 hours with an incremental increase of temperatures of 0.2 – 0. 5º.

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About the author

Dr A W Niranjan Thomas

Professor and Head Unit 1,

Department of Neonatology,

Christian Medical College, Vellore

References

^{1. S, Thoresen M. Therapeutic hypothermia in neonates. Review of current clinical data, ILCOR recommendations and suggestions for implementation in neonatal intensive care units. Resuscitation, 2008;78(1):7-12.}

^{2. Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cooling for newborns with hypoxic ischemic encephalopathy. Cochrane Database Syst Rev 2007;(4):CD003311.}

^{3. Jacobs SE at al., Whole-Body Hypothermia for Term and Near-Term Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Controlled Trial. Arch PediatrAdolesc Med. 2011, Aug 1;165(8):692.}

^{4. Shankaran S. Hypoxic-ischemic encephalopathy and novel strategies for neuroprotection. Clin Perinatol. 2012 Dec;39(4):919–29.}

^{5. Kapetanakis A, Azzopardi D, Wyatt J, Robertson NJ. Therapeutic hypothermia for neonatal encephalopathy: a UK survey of opinion, practice and neuro-investigation at the end of 2007.}