Effect of hypothermia for perinatal asphyxia on childhood outcomes

Santhosh Jose, Mohamad Ismael K.


Background: Perinatal asphyxia, neonatal asphyxia or birth asphyxia is the medical condition resulting from deprivation of oxygen to a new born infant that lasts long enough during the birth process to cause physical harm, usually to the brain. This study was performed to evaluate study population who were 6 to 8 years of age to determine whether the application of moderate hypothermia after perinatal asphyxia is associated with long term benefits.

Methods: This study was a randomised, controlled trials which consisted of infants who were admitted with moderate and severe encephalopathy within 6 hours after birth after an acute perinatal event, with acidosis or resuscitation. Infants were assigned to undergo whole body hypothermia at 33ºC for 72 hours or to undergo usual care randomly.

Results: All maternal baseline characteristics and Neonatal characteristics are non significant in both groups. APGAR score ≤5 is significant at 10mins in comparison. cerebral palsy were 18% and 25%, respectively, the rates of blindness were 1% and 4% the rates of hearing impairment (requiring aids) were 5.4% and 12.8%. There were no significant between-group differences in the level of disability among all survivors or in motor function among the 45 nondisabled children. Among children who had moderate or severe disability at 18 months, the corresponding rates at 6 to 7 years of age were 88% in the hypothermia group and 95% in the control group. All the children who had moderate-to-severe cerebral palsy at 18 months continued to be affected at 6 to 7 years in both groups. There was no significant between-group difference with respect to IQ scores that were measured on a continuous scale and other scores, with the exception of 1 of the 11 scores compared (attention and executive function, P=0.03). There were also no significant differences between groups in mean scores on the index of health care status derived from parental assessments or in parental scores for children’s strengths and difficulties and ADHD The mean difference in the academic achievement score favored the hypothermia group but was not significant.

Conclusions: Moderate hypothermia after perinatal asphyxia resulted in improved neurocognitive outcomes in middle childhood. 


Cerebral blood flow, Neonatal asphyxia, Perinatal asphyxia

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Aslam HM, Saleem S, Afzal R, Iqbal U, Saleem SM, Shaikh MWA et al. Risk factors of birth asphyxia and quot. Italian J Pediatr. 2014;40:94.

Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Lancet. 2004;364(9442):1329-33.

Kutzsche S, Ilves P, Kirkeby OJ, Saugstad OD. Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with 100% or 21% oxygen in newborn piglets. Pediatr Res. 2001;49(6):834-42.

Kaye D. Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda. East Afr Med J. 2003;80(3):140-3.

Cowan F, Rutherford M, Groenendaal F, Eken P, Mercuri E, Bydder GM et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet. 2003;361(9359):736-42.

Becher JC, Stenson BJ, Lyon AJ. Is intrapartum asphyxia preventable?. BJOG: Int J Obstet Gynaecol. 2007 Nov ;114(11):1442-4.

Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165:692-700.

Simbruner G, Mittal RA, Rohlmann F, Muche R. Systemic hypothermia after neonatal encephalopathy: outcomes of RCT. Pediatrics. 2010;126(4):e771-e778.

Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010;157:367-72.

Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicenter randomised trial. Lancet. 2005;365:663-70.

Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol. 2005;32:11-7.

Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF et al. Whole-body hypothermia for neonates with hypoxic–ischemic encephalopathy. N Engl J Med. 2005;353:1574-84.

Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361:1349-58.

Ambalavanan N, Carlo WA, Shankaran S, Bann CM, Emrich SL, Higgins RD et al. Predicting outcomes of neonates diagnosed with hypoxemic-ischemic encephalopathy. Pediatrics. 2006;118(5):2084-93.