Therapeutic hypothermia for asphyxiated newborns: Experience of an Israeli tertiary center

Background: Major advances in the treatment of perinatal asphyxial-hypoxic ischemic encephalopathy (PA-HIE) followed the translation of hypothermia animal studies into successful randomized controlled clinical trials that substantially influenced the current standard of care. Objectives: To present our preliminary experience with the first cases of clinical application of therapeutic hypothermia for PA-HIE in what we believe is the first report on nonexperimental hypothermia for PA-HIE from Israel. Methods: We reviewed the medical records, imaging scans, electroencephalograms and outcome data of the six identified asphyxiated newborns who were managed with hypothermia in our services in 2008-2009. Results: All asphyxiated newborns required resuscitation and were encephalopathic. Systemic hypothermia (33.5°C) was begun at a median age of 4.2 hours of life (range 2.5-6 hours) and continued for 3 days. All six infants showed a significantly depressed amplitude integrated electroencephalography background, and five had electrographic seizures. One infant died (16%) after 3.5 days. Major complications included fat necrosis and hypercalcemia (n=1), pneumothorax (n=1), and meconium aspiration syndrome (n=2). None of the infants developed major bleeding. Neurodevelopmental followup of the five surviving infants at median age 7.2 months (4.1-18.5 months) revealed developmental delays (Battelle screening), with their motor scores ranging from -1 to +1 standard deviation (Bayley scale). None developed feeding problems, oculomotor abnormalities, spasticity or seizures. Conclusions: Our preliminary experience with this novel modality in a large Tel Aviv neonatal service is consistent with the clinical findings of published trials.