Neonatal Hypothermia

A Method to Provide Neuroprotection After Hypoxic Ischemic Encephalopathy

Katherine M. Newnam, MS, RN, CPNP, NNP-BC; Donna L. DeLoach, MS, RN, CPNP, NNP-BC

Disclosures

NAINR. 2011;11(3):113-124. 

In This Article

Long-term Developmental Outcomes

As described earlier in the article, regardless of interventions, often, the degree of long-term complications depends on the degree of the injury, which is initially difficult to predict.[40] This information combined with described outcomes from early clinical trials underscores that decision making, for these patients can be very complex. In a review by Barks,[36] concerns about severe disability replacing the option for death, providing cooling may interfere with the opportunity to withdraw support in the appropriate cases. Cochrane meta-analysis does not support these concerns, as treatment with hypothermia decreased both death and disability.[2] Ultimately, pediatric palliative or hospice resources may be indicated/needed, in spite of the best medical technology.[34]

In previously studied children with HIE who were not cooled, the largest deficits were in hearing and speech, which are clearly crucial in all other aspects of learning.[44] Although newer studies may not bear out the same frequency of deficits of this kind, there importance, nevertheless, cannot be diminished because of their impact on the family. Subtle disabilities, not measurable at the younger ages, will sometimes declare themselves at or near the school age.[44]

Evaluations of infants with moderate HIE who were not cooled showed no difference between controls in general cognitive ability , but these children went on to demonstrate less ability in language/sensorimotor domains, narrative memory, and sentence repetition in the absence of overt sensorimotor impairment.[8] Advanced imaging now provides information to correlate the location and extent of brain injuries to potential outcomes.[9] Infants with certain types of injuries (watershed pattern), which would be discernible on MRI, often are normal at 12- to 18-month neurodevelopmental evaluations but go on to exhibit suboptimal head growth, behavioral problems, problems with language acquisition, and squinting.[8]

The relationship of the interventional therapy currently available (therapeutic hypothermia) on children's long-term outcome is yet to be determined by studies.[45] Later evaluations would include fine motor development, executive function and attention deficits and/or ability, and psychologic outcomes, along with previously mentioned testing.[45]

The importance of early identification of infants at risk and provision for early intervention and follow-up cannot be overstated. Care providers should strive to identify these children to maximize their potential for independent function.[9] Moderately affected children may have conditions resulting in delayed school entry and requiring additional educational support. Delays may include increased hyperactivity, visual-motor or visual-perceptive dysfunction, and memory impairment. Children with severe HIE have greater risk of cerebral palsy and mental retardation.[9] The age at which the diagnosis of cerebral palsy can be confirmed is not until 5 years.[42] Long-term follow-up is indicated to assess the needs as they evolve. One must also consider the importance of environment, socioeconomic conditions, access to follow-up, and interventional therapy on neurodevelopmental outcomes.[9] Lastly, follow-up affords the clinician to reassure those parents of children with favorable outcomes that they are progressing normally and that special interventions are not indicated.[44]

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