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Risk factors affecting the outcome of newborns undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy

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Authors: R. Poláčková 1;  J. Kučová 2,3;  Z. Švagera 4,5;  L. Kantor 6;  D. Šalounová 7
Authors‘ workplace: Katedra dětského lékařství a neonatologie, Lékařská fakulta Ostravské univerzity, Ostrava 1;  Oddělení neonatologie, Fakultní nemocnice Ostrava 2;  Ústav ošetřovatelství a porodní asistence, Lékařská fakulta Ostravské univerzity, Ostrava 3;  Ústav laboratorní diagnostiky, Fakultní nemocnice Ostrava 4;  Katedra biomedicínských oborů, Lékařská fakulta Ostravské univerzity, Ostrava 5;  Novorozenecké oddělení, Fakultní nemocnice a Lékařská fakulta Univerzity Palackého, Olomouc 6;  Katedra matematických metod v ekonomice, Vysoká škola báňská – Technická univerzita, Ostrava 7
Published in: Čes-slov Pediat 2019; 74 (1): 30-40.
Category: Original Papers

Overview

Aim of the study:

To evaluate the role of potential risk factors and biochemical parameters in the outcome, at 24 months of age, of newborns treated by therapeutic hypothermia for stage II and III hypoxic-ischemic encephalopathy.

Material and methods:

This prospective study comprised 51 newborns, of gestation age from 36–41 weeks, who were undergoing hypothermia treatment for stage II and III hypoxic-ischemic encephalopathy. Various risk factors were noted and monitored including birthplace, time hypothermia treatment was initiated, birth weight, Apgar score at 5 and 10 minutes of life, occurrence of seizures, serum lactate values, and lactate dehydrogenase. At 24 months, the patients were assessed and consequently divided into two groups. Patients placed in one group exhibited normal psychomotor development and were therefore judged to have positive treatment outcomes; the other group comprised those who displayed severely compromised motor coordination or sensory impairment, or even died. In each group specific risk factors were subsequently evaluated to determine their influence on treatment outcome.

Results:

Seven infants died during the course of the study. Of the remaining 44 examined at 2 years old, 34 exhibited positive psychomotor development, with adverse findings in 10 cases. The risk factors associated with adverse treatment outcome were noted to be low Apgar score at 5 and 10 minutes, seizures resistant to treatment, initial pH values, base excess, and lactate and lactate dehydrogenase in arterial blood at the time of admission. While both patient groups saw a significant reduction in lactate values over the course of hypothermia treatment, it was nevertheless clear that there were significant statistical differences in observed values.

Conclusion:

Elevated serum lactate values, lactate dehydrogenase early in the period post-asphyxia, and seizure activity resistant to pharmacotherapy are indicative of adverse outcomes in newborns receiving therapeutic hypothermia for stage II and III hypoxic-ischemic encephalopathy.

Keywords:

lactate – hypoxic-ischemic encephalopathy – therapeutic hypothermia – outcome – seizures

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