Neonatal Updates : Therapeutic hypothermia

Three recent articles dealing with the effects of therapeutic hypothermia:

Drury PP, Gunn ER, Bennet L, Gunn AJ. Mechanisms of Hypothermic Neuroprotection. Clin Perinatol. 2014;41(1):161-75. the first is an excellent review article describing how hypothermia works, SPOILER ALERT, its mostly about apoptosis.

Hochwald O, Jabr M, Osiovich H, Miller SP, McNamara PJ, Lavoie PM. Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy. The Journal of pediatrics. 2014. Left ventricular outputs during cooling were much lower than health controls, and increased with re-warming. SVC flows in contrast were similar to health infants, and didn’t change during re-warming. Suggesting that there is a redistribution of blood flow to the upper body, probably the brain. Maybe the lack of a decrease in SVC flow during cooling shows that the cerebral vessels are reacting abnormally to hypothermia, and maybe that is a good thing.

Nestaas E, Skranes JH, Støylen A, Brunvand L, Fugelseth D. The myocardial function during and after whole-body therapeutic hypothermia for hypoxic–ischemic encephalopathy, a cohort study. Early Human Development. 2014. A comparison of features of myocardial function by echocardiography between hypothermic babies, and a historical control group treated before hypothermia became standard, and a group of healthy controls. Most of the data presented are derived from tissue doppler studies. The indices of function were similar between the 2 asphyxiated groups, even though the hypothermia treated seemed to probably have a more severe insult. All the indices recovered to be near normal after re-warming.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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