Hypothermia and intraventricular hemorrhage

Natalia Gorelik, Ricardo Faingold, Alan Daneman, Monica Epelman.  Intraventricular hemorrhage in term neonates with hypoxic-ischemic encephalopathy: a comparison study between neonates treated with and without hypothermia.  Quantitative Imaging in Medicine and Surgery. Vol 6, No 5 (October 2016)

Abstract

Background: To retrospectively determine the prevalence of intraventricular hemorrhage (IVH) in term neonates with hypoxic-ischemic encephalopathy (HIE) using head ultrasound (HUS) and MRI, and to compare the incidence of IVH in term babies with HIE treated by therapeutic hypothermia versus those managed conventionally.

Methods: A total of 61 term neonates from two institutions were diagnosed with HIE shortly after birth. Thirty infants from one institution were treated with whole body hypothermia. These infants had to satisfy the entry criteria for the neonatal hypothermia protocol of the institution. Thirty-one neonates underwent conventional treatment at the second institution. At that time, hypothermia was not yet a standard of care at that institution. All the neonates underwent HUS in their first 23 days of life. The 54 survivors also underwent MRI. The imaging studies were all reviewed for IVH.

Results: Amongst the 30 babies, who received whole body hypothermia, there were 18 males and 12 females, the mean birth weight was 3.5 kg (2.5 to 5.2 kg), and the HUS study was performed within 14.8 to 41 hours of life. The group of 31 infants treated conventionally was comprised of 12 boys and 19 girls, the infants had an average birth weight of 3.3 kg (2.3 to 4.2 kg), and they underwent HUS 1 to 23 days after birth, with only five children being older than 1 week at the time of the imaging studies. Four of the 61 infants (7%) were diagnosed with IVH on HUS. Three were confirmed with MRI. The fourth case showed a bilateral enlarged choroid plexus on HUS, but IVH could not be confirmed with MRI, as the infant did not survive. In the group of neonates treated with hypothermia, there were three cases (10%) of IVH, whereas in the group managed conventionally, IVH occurred in one infant (3%).

Conclusions: Our study shows that IVH remains uncommon in term infants with HIE. IVH was more prevalent in the group treated with hypothermia.

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With the aim to retrospectively determine the prevalence of intraventricular hemorrhage (IVH) in term neonates with hypoxic–ischemic encephalopathy (HIE) using head ultrasound (HUS) and MRI, and to compare the incidence of IVH in term babies with HIE treated with therapeutic hypothermia vs. those managed conventionally. In this study, the researchers demonstrate that IVH remains uncommon in term infants with HIE. In the group treated with hypothermia, IVH was more prevalent.

Methods

• The researchers diagnosed 61 term neonates from 2 institutions with HIE shortly after birth.
• They treated 30 infants from 1 institution with whole body hypothermia.
• These infants had to satisfy the entry criteria for the neonatal hypothermia protocol of the institution.
• At the second institution, 31 neonates underwent conventional treatment.
• At that time, hypothermia was not yet a standard of care at that institution.
• In their first 23 days of life, all the neonates underwent HUS.
• The 54 survivors also underwent MRI.
• In this study, the imaging studies were all reviewed for IVH.

Results

• There were 18 males and 12 females amongst the 30 babies, who received whole-body hypothermia, the mean birth weight was 3.5 kg (2.5 to 5.2 kg), and the HUS study was performed within 14.8 to 41 hours of life.
• The group of 31 infants treated conventionally was comprised of 12 boys and 19 girls, the infants had an average birth weight of 3.3 kg (2.3 to 4.2 kg), and they underwent HUS 1 to 23 days after birth, with only 5 children being older than 1 week at the time of the imaging studies.
• On HUS, 4 of the 61 infants (7%) were diagnosed with IVH.
• With MRI, 3 were confirmed.
• The 4^th case demonstrated a bilateral enlarged choroid plexus on HUS, but IVH could not be confirmed with MRI, as the infant did not survive.
• There were 3 cases (10%) of IVH in the group of neonates treated with hypothermia, whereas in the group managed conventionally, IVH occurred in 1 infant (3%).

https://www.mdlinx.com/neurology/medical-news-article/2016/11/14/intraventricular-hemorrhage-hypoxic-ischemic-encephalopathy/6928413/?category=latest&page_id=1