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December 24/31, 2014

Depth and Duration of Cooling for Perinatal Asphyxial Encephalopathy

Author Affiliations
  • 1Institute for Women's Health, University College London, United Kingdom

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(24):2623-2624. doi:10.1001/jama.2014.15959

Therapeutic hypothermia for perinatal asphyxial encephalopathy, the neurological syndrome that follows acute intrapartum hypoxia, is one of the major success stories in neonatology of the past 25 years1; it is an excellent example of laboratory to bedside research and of the critical importance of randomized clinical trials. Since 1999, when the first neonate was enrolled in a clinical trial of cooling therapy,2 5 major randomized clinical trials have been conducted to evaluate induced whole-body hypothermia at 33°C to 34°C for 72 hours, as part of the intensive care surrounding perinatal asphyxial encephalopathy.26 All of these trials have demonstrated a decrease in death or disability following encephalopathy with cooling. The benefit lasts into childhood,79 and in the most recent report for the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) Children Study, cooling seemed to improve the more subtle neurocognitive outcomes associated with hypoxic brain injury.9 Despite these benefits, there remain concerns that approximately half of children who are cooled still die or survive with significant impairments despite cooling, and the search continues to refine or supplement hypothermic neuroprotection.

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