Viktorija Zamaliauskaitė1, Renata Dzikienė2
1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
2Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Department of Neonatology, Kaunas, Lithuania
Bacground. Perinatal asphyxia and neonatal hypoxic ischemic encephalopathy (HIE) result in high mortality. Therapeutic hypothermia (TH) is known to improve the outlying outcomes of these patients, but there are still questions about how to treat patients who do not meet the eligibility criteria for treatment set out in the guidelines. The aim: to analyze and compare the outcome of preterm infants diagnosed with hypoxic-ischemic encephalopathy and treated with therapeutic hypothermia, and patients with therapeutic hypothermia applied after more than 6 hours after birth.
Methods. Analysis of articles published in the last 5 years evaluating outcomes of preterm infants (<36 weeks) with hypoxic ischemic encephalopathy diagnosis and treated with therapeutic hypotermia, and neonates treated with therapeutic hypothermia after 6 hours after birth.
Results. The review included 4 studies analyzing issues of effectiveness and safety of substandard treatments. No significant results of neonatal survival were found between the comparator patient groups. Data on mental and psychomotor developmental disorders between term and preterm infants in the adjusted age of 18 and 24 months also did not differ significantly. The studies showed better outcomes in those neonates who did not meet the criteria for therapeutic hypothermia than in those who did not receive therapeutic treatment at all.
Conclusions. Studies show that therapeutic hypothermia is increasingly being attempted in preterm infants diagnosed with hypoxic-ischemic encephalopathy and in neonates with more than 6 hours postpartum, but this is not included in the general guidelines due to a lack of evidence. There is a lack of a large-sample studies. This demonstrates the need for more researches to evaluate the safety and efficacy of treatment in this population.
Keywords: preterm infants, late therapeutic hypothermia, hypoxic-ischemic encephalopathy, hypoxia.