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Therapeutic Hypothermia in a Tertiary Reference Center of Rio de Janeiro

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Abstract

Purpose of Review

The study aims to show how the use of therapeutic hypothermia can provide neurological protection to asphyxiated newborns, as we evaluated 56 children in a tertiary-care teaching hospital in the state of Rio de Janeiro.

Recent Finding

Implementing hypothermia protocol in asphyxiated newborns can reduce asphyxia morbidity and mortality in developing countries, such as Brazil. This technique improves the quality of life of a significant number of infants.

Summary

Approximately 3 in every 1000 full-term births suffer with perinatal asphyxia, one of the main causes of hypoxic-ischemic encephalopathy (HIE) in newborns, which has a significant mortality range. Between survivors of perinatal asphyxia, 25 to 30% have cerebral paralysis as the most important sequelae, in addition to mental retardation, learning deficits to varying degrees, and epilepsy. The use of therapeutic hypothermia protocol in asphyxiated newborns will positively affect neurodevelopment, reducing damages and helping repair functions that asphyxia might have caused.

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Authors and Affiliations

  1. Department of Pediatrics, Medical Sciences College, UERJ, Rio de Janeiro, Brazil

    Eduardo Jorge Custódio da Silva & Jose Luiz Muniz Bandeira Duarte

  2. Neonatal Intensive Care Unit, Ernesto University Hospital, UERJ, PedroRio de Janeiro, Brazil

    Eduardo Jorge Custódio da Silva, Sheila Mariah de Sá Finni Prado Chaves, Lucia Helena Wagner & Jose Luiz Muniz Bandeira Duarte

  3. Neuropediatras Associados LTDA, Rio de Janeiro, Brazil

    Maria Eduarda Ragghiante Ferreira & Eduardo Jose Berardo Zaeyen

Authors
  1. Eduardo Jorge Custódio da Silva
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  2. Maria Eduarda Ragghiante Ferreira
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  3. Eduardo Jose Berardo Zaeyen
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  4. Sheila Mariah de Sá Finni Prado Chaves
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  5. Lucia Helena Wagner
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  6. Jose Luiz Muniz Bandeira Duarte
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Corresponding author

Correspondence to Eduardo Jorge Custódio da Silva.

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Appendices

Appendix 1

  1. 1-

    Gasometry inclusion criteria 1st hour: pH < 7,0 or BE ≤  − 16 mEq/L or APGAR no 10° min ≤ 5 or ventilation > 10 min;

Thompson’s score ≥ 8 hypothermia was started;

Start of hypothermia with until 6 h of life.

Signature of TCLE.

Exclusion criteria:

  • Gestational age < 35 weeks;

  • Weight at birth < 1800 g;

  • Congenital malformations incompatible with life

  • After 24 h of life.

Appendix 2. Procedures for Hypothermia

  • The newborn (RN) is put into the Radiant Heat Unit (RHU), with heating turned off, on top of the hypothermia garment. Place the “Bristol” pillow between the newborn’s head and the garment.

  • The newborns were placed in the Radiant Heat Unit (RHU) turned off and covered with the weight appropriate garment/mattress recommended by the servo-controlled cooling system.

The central temperature in the cooling phase (cooling) must be kept in 33.5 °C.

At the end of induced hypothermia, the target temperature was readjusted to increase by 0.5 °C per hour to a rectal temperature of 36.5 °C. After completion of rewarming the patient was maintained for at least 6 h in normothermia mode before the garment was removed.

The central temperature measurement was maintained for 24 h after the end of rewarming to prevent rebound hyperthermia.

  • Placement of double-lumen umbilical catheters, as well as a peripheral access.

  • Placement of temperature sensors:

  • Rectal or esophageal: 2 thermometers: 1 sensor connected to the monitor and the other connected to the cooling system. The esophageal sensor r in the middle 1/3 of the esophagus and the rectal at 6 cm.

  • Cutaneous: surface sensor of the equipment placed on the side of the arm (in a non-cooled area).

  • Sensor placement for aEEG monitoring and routine monitoring.

  • Induction of moderate hypothermia for 72 h, using servo-controlled cooling.

The objective was to maintain a central temperature of 33.5 ± 0.5 °C for 96 h.

The patients had specific ventilation, hydroelectrolytic, cardiovascular, hematological, physiotherapeutic, and nutritional support.

Follow

  • Daily neurological examination using Thompson’s score until day 7.

  • Transfontanellar ultrasound with Doppler in 7 days, ideally on day 1.

  • Magnetic resonance of skull between D5 and D14 of life, ideal D7.

  • Pre-discharge hearing and ophthalmologic evaluation.

  • Follow-up consultation with neonatologist.

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da Silva, E.J.C., Ferreira, M.E.R., Zaeyen, E.J.B. et al. Therapeutic Hypothermia in a Tertiary Reference Center of Rio de Janeiro. Curr Pediatr Rep 11, 61–68 (2023). https://doi.org/10.1007/s40124-023-00289-0

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  • DOI: https://doi.org/10.1007/s40124-023-00289-0

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