RISK FACTORS FOR LOW EFFICACY OF THERAPEUTIC HYPOTHERMIA IN TERM INFANTS WITH ASPHYXIA

Abstract

Summary. Therapeutic hypothermia is currently the standard of care for infants with moderate and severe asphyxia at birth. But it is not able to permanently prevent the adverse effects of severe asphyxia. It is possible to predict the effectiveness of the therapeutic hypothermia, and the very early recognition of the patients with the largest risk of severe neurological impairment and death, is practically important. The aim of the study was to investigate the risk factors for low efficacy of therapeutic hypothermia initiated in the first three hours of life in term infants with asphyxia at birth. Materials and methods. We have retrospectively analyzed data cohort of 83 full-term infants that had severe asphyxia at birth with therapeutic hypothermia initiation during the first three hours of life. 56 children had a mild pathology. 27 children had severe pathology (died within the first month of life or had signs of irreversible destructive lesions of the CNS). The factors of risk of pregnancy, childbirth, peculiarities of assessment of the clinical condition of children during the first day of life were analyzed. Results. The group of newborn infants with adverse post-ischemic CNS lesions compared with the favorable prognosis group was more likely to have an indirect cardiac massage during neonatal resuscitation (13 (48.1%) children versus 8 (14.3%), p=0.001), lower Apgar scores at the 10th minute of life (3.50±0.67 vs. 5.68±0.25, p=0.005), lower pH at the time of hospitalization (7.26±0.03 vs. 7.33±0.01, p=0.037), with more frequent signs of multiple organ failure (13 (48.1%) vs 7 (12.5%), p=0.007) and severe hypoxic-ischemic encephalopathy (12 (44.4%) children vs. 6 (10.7%), p=0.001), lower values of the anterior cerebral artery resistance index (0.64±0.04 vs. 0.71±0.02, p=0.041) in the first day of life. There were also slight significant associations between adverse disease and preeclampsia during pregnancy (R=0.315) and fetal distress (R=0.267). Conclusions. Predicting the effects of treatment of newborns with hypoxic-ischemic encephalopathy with therapeutic hypothermia can be made on the basis of analysis of anamnestic data and evaluation of clinical data dynamics during the first day of life.

Keywords

• Asphyxia
• Hypoxic Ischemic Encephalopathy
• Hypothermia
• Risk Factors
• Newborns