Evolution of the Therapeutic Effects of Induced Local Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy

Introduction & Hypoxic-ischemic encephalopathy is one of the most important causes of permanent damage to brain tissue that redound to mortality and/or late sequelae such as cerebral palsy or delayed neural development. 15-20 percent of Hypoxic-ischemic encephalopathy (HIE) cases die during neonatal period and 25-30 percent of those who survive suffer from neural development problems such as cerebral palsy and mental retardation. Hypothermia or lowering temperature of brain or total body is a new and promising treatment. The present study was done to assess therapeutic effects of induced local hypothermia in hypoxic-ischemic encephalopathy (HIE) among neonates admitted to Fatemieh and Beset hospitals of Hamadan city. The present study was performed as a randomized clinical trial upon 36 neonates who had inclusion criteria to be imported into the study. In the first 6 hours after birth, the neonates were randomly classified into two 18 person groups. In the control group the neonates were managed with routine treatments consisted of preservative measures and anti-convulsive treatments, if necessary. In the case group the neonates received induced local hypothermia for 6 hours in addition to routine therapeutic managements. The data were analyzed using SPSS Version 13. 72.7% of the neonates of the case and control groups were male. There was no significant difference between the case and control groups in sex, birth weight, gestational age and perinatal obstetric complications. The mean duration of admission was 7.72±4.23 days in the case group and 10.06±5.99 days in the control group with no significant difference between the two groups (P=0.199). The mean time of starting oral feeding was 3.44±3.11 days and 4.53±2.74 days in the control and case groups respectively and this difference was not statistically significant either (P=0.737).The mean time of regaining consciousness was 3.72±3.19 days in the case group and 4.80± 3.34 days in the control group, and here again there was no statistically significant difference between the two groups (P=0.606). With respect to seizure we noticed a statistically significant difference (P=0.038) between the two groups after observing 16.7% of the neonates in the case group and 50% of the neonates in the control group with seizure. 3 neonates in the group who received routine managements died whereas no death was observed among the patients receiving hypothermia. We saw no difference in the mortality rate between the two groups (P=0.114) using statistical test. In the present study it seems that performing local hypothermia as a therapeutic measure can reduce seizure rate because seizure rate among the patients receiving only local hypothermia was significantly lower than the patients receiving routine