Early Outcomes of Perinatal Asphyxia Management with Cool-Cap®️ and Blanket
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Jul 4, 2023
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Ayelet Ramírez-Corredor
https://orcid.org/0000-0001-7318-358X
Claudia Devia-Neira
https://orcid.org/0000-0002-0764-2802
Yaris Anzully Vargas-Vacca
https://orcid.org/0000-0002-7006-7660
Ana María Bertolotto-Cepeda
https://orcid.org/0000-0001-9795-6866
Adriana Patricia Bohórquez-Peñaranda
https://orcid.org/0000-0002-6880-6516
https://orcid.org/0000-0001-7318-358X
Claudia Devia-Neira
https://orcid.org/0000-0002-0764-2802
Yaris Anzully Vargas-Vacca
https://orcid.org/0000-0002-7006-7660
Ana María Bertolotto-Cepeda
https://orcid.org/0000-0001-9795-6866
Adriana Patricia Bohórquez-Peñaranda
https://orcid.org/0000-0002-6880-6516
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Abstract
Introduction: Short-term results obtained with body cooling using Cool-cap®️ and blanket are controversial. The outcomes of the two intervention modalities are presented under the same protocol and institution. Patients and methods: ambidirectional cohort study of newborns with moderate or severe perinatal asphyxia treated with controlled hypothermia between 2018 and 2020 in a hospital in Bogotá, Colombia Results: 164 patients received therapeutic hypothermia with the mentioned devices (Cool-cap®️ 54,2 %; Manta 45,7%). Mortality was 11,2% and 16% respectively, with a higher proportion of patientes with sarnat III in the latter group (16 % vs. 6 %). The Cool-cap®️ group presented more cardiovascular disorders (60 %); pulmonary hypertension and hematological disorders had a similar proportion in both groups. In both interventions, more than half of the patients were admitted outside therapeutic window period and had an overall mortality of 14,8 % (Cool-cap®️ n=7 and blanket n=7) Conclusions: overall mortality was 13,4%, lower than the one reported in literature, which varies between 14% and 20%, despite the fact thar more than half of the patients were admitted outside the therapeutic window period. This being greater in the blanket group, a difference that is explained by the disparity in the distribution of the prognostic factors at admission of both groups.
Keywords
hypoxic-ischemic, asphyxia, newborn, therapeutic hypothermia, prognosishipoxia-isquemia, asfixia, neonato, hipotermia terapéutica, pronóstico
References
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10. Laptook AR, Shalak L, Corbett RJ. Differences in brain temperature and cerebral blood flow during selective head versus whole-body cooling. Pediatrics. 2001;108(5):1103-10. https://doi.org/10.1542/peds.108.5.1103
11. Goenka A, Yozawitz E, Gomes WA, Nafday SM. Selective head versus whole body cooling treatment of hypoxic-ischemic encephalopathy: comparison of electroencephalogram and magnetic resonance imaging findings. Am J Perinatol. 2020 Oct 1;37(12):1264-70. https://doi.org/10.1055/s-0039-1693466
12. Celik Y, Atici A, Gulasi S, Okuyaz C, Makharoblidze K, Sungur MA. Comparison of selective head cooling versus whole-body cooling. Pediatr Int. 2016 Jan 1;58(1):27-33. https://doi.org/10.1111/ped.12747
13. Sarkar S, Barks JD, Bhagat I, Donn SM. Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: whole-body cooling versus selective head cooling. J Perinatol. 2009;29(8):558-63. https://doi.org/10.1038/jp.2009.37
14. Socha PIR, Del Riesgo Prendes L, Estad MIP, Torres VR. Fatores de risco associados a asfixia perinatal no Hospital Universitário Méderi, 2010-2011. Rev Cienc Salud. 2017;15(3):345-56. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.6118
15. Sánchez YC, Ausecha L, Pérez CF, Pacheco R. Frecuencia y determinantes de la asfixia perinatal en un servicio especializado de Popayán Colombia 2014. Interdiscip J Epidemiol Public Heal. 2018;1(2):1-8. https://doi.org/10.18041/2665-427x/ijeph.2.5286
16. Departamento Administrativo Nacional de Estadística. Estadísticas Vitales (EEVV): nacimientos en Colombia [internet]. Bogotá; 2021. Disponible en: https://www.dane.gov.co/index.php/estadisticas-por-tema/salud/nacimientos-y-defunciones//
17. Martínez-Biarge M, Madero R, González A, Quero J, García-Alix A. Perinatal morbidity and risk of hypoxic-ischemic encephalopathy associated with intrapartum sentinel events. Am J Obstet Gynecol. 2012;206(2):148.e1-148.e7. https://doi.org/10.1016/j.ajog.2011.09.031
18. Xu EH, Claveau M, Yoon EW, Barrington KJ, Mohammad K, Shah PS, et al. Neonates with hypoxic-ischemic encephalopathy treated with hypothermia: Observations in a large Canadian population and determinants of death and/or brain injury. J Neonatal Perinatal Med. 2020;13(4):459-61.
19. Manotas H, Troncoso G, Sánchez J, Molina G. Descripción de una cohorte de pacientes neonatos con diagnóstico de asfixia perinatal, tratados con hipotermia terapéutica. 2017. Perinatología. 2018;32(2):70-7. https://doi.org/10.1016/j.rprh.2018.07.001
20. Jia W, Lei X, Dong W, Li Q. Benefits of starting hypothermia treatment within 6h vs. 6-12h in newborns with moderate neonatal hypoxic-ischemic encephalopathy. BMC Pediatr. 2018 Feb 12;18(1). https://doi.org/10.1186/s12887-018-1013-2
21. García-Alix A, Arnaez J, Cortés V, Girabent-Farres M, Arca G, Balaguer A. Neonatal hypoxic-ischaemic encephalopathy: most deaths followed end-of-life decisions within three days of birth. Acta Paediatr Int J Paediatr. 2013 Dec 1;102(12):1137-43. https://doi.org/10.1111/apa.12420
22. Armstrong K, Franklin O, Sweetman D, Molloy EJ. Cardiovascular dysfunction in infants with neonatal encephalopathy. Arch Dis Child. 2012;97(4):372-5. https://doi.org/10.1136/adc.2011.214205
23. Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004;89(2):F152-5. https://doi.org/10.1136/adc.2002.023093
24. Szakmar E, Jermendy A, El-Dib M. Respiratory management during therapeutic hypothermia for hypoxic-ischemic encephalopathy. J Perinatol. 2019;39(6):763-73. https://doi.org/10.1038/s41372-019-0349-2
25. Piñeros JG, Troncoso G, Serrano C, Espinosa E. Diagnóstico, manejo, monitoreo y seguimiento del recién nacido con asfixia perinatal, encefalopatía hipóxico isquémica e hipotermia terapéutica [internet]. Bogotá: Asociación Colombiana de Neonatología; 2021. Disponible en: https://ascon.org.co/wp-content/uploads/2021/02/CONSENSO-NEUROLOGIA-Y-NEONATOLOGIA1.pdf
26. Alaro D, Bashir A, Musoke R, Wanaiana L, Bashir A. Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia. Afr Health Sci [internet]. 2014 [citado 2021 may 25];14(3):682-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25352889/
2. Organización Mundial de la Salud. Mejorar la supervivencia y el bienestar de los recién nacidos. Nota Descr [internet]. 2020;1-6. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/newborns-reducing-mortality
3. Adolph G, Troncoso G, Solano JM, Piñeros MC, Lengua MF, Benítez DC. Lineamiento técnico para el manejo de la asfixia perinatal [internet]. Bogotá: Secretaría Distrital de Salud; 2015. Disponible en: http://www.saludcapital.gov.co/DDS/Guas%20de%20Asfixia%20Perinatal/Gu%C3%ADa%20de%20Asfixia%20Perinatal.pdf
4. Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012;166(6):558-66. https://doi.org/10.1001/archpediatrics.2011.1772
5. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD003311. https://doi.org/10.1002/14651858.CD003311.pub3
6. Shah PS. Hypothermia: a systematic review and meta-analysis of clinical trials. Semin Fetal Neonatal Med. 2010 Oct;15(5):238-46. https://doi.org/10.1016/j.siny.2010.02.003
7. Papile LA, Baley JE, Benitz W, Cummings J, Carlo WA, Eichenwald E, et al. Hypothermia and neonatal encephalopathy. Pediatrics. 2014 Jun 1;133(6):1146-50. https://doi.org/10.1542/peds.2014-0899
8. Gillam-Krakauer M, Gowen Jr CW. Birth asphyxia [internet]. Treasure Island (FL): StatPearls Publishing; 2021 [citado 2021 mar 27]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/28613533
9. Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thoresen M, et al. The TOBY study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: A randomised controlled trial. BMC Pediatr. 2008 Apr 30;8:17. https://doi.org/10.1186/1471-2431-8-17
10. Laptook AR, Shalak L, Corbett RJ. Differences in brain temperature and cerebral blood flow during selective head versus whole-body cooling. Pediatrics. 2001;108(5):1103-10. https://doi.org/10.1542/peds.108.5.1103
11. Goenka A, Yozawitz E, Gomes WA, Nafday SM. Selective head versus whole body cooling treatment of hypoxic-ischemic encephalopathy: comparison of electroencephalogram and magnetic resonance imaging findings. Am J Perinatol. 2020 Oct 1;37(12):1264-70. https://doi.org/10.1055/s-0039-1693466
12. Celik Y, Atici A, Gulasi S, Okuyaz C, Makharoblidze K, Sungur MA. Comparison of selective head cooling versus whole-body cooling. Pediatr Int. 2016 Jan 1;58(1):27-33. https://doi.org/10.1111/ped.12747
13. Sarkar S, Barks JD, Bhagat I, Donn SM. Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: whole-body cooling versus selective head cooling. J Perinatol. 2009;29(8):558-63. https://doi.org/10.1038/jp.2009.37
14. Socha PIR, Del Riesgo Prendes L, Estad MIP, Torres VR. Fatores de risco associados a asfixia perinatal no Hospital Universitário Méderi, 2010-2011. Rev Cienc Salud. 2017;15(3):345-56. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.6118
15. Sánchez YC, Ausecha L, Pérez CF, Pacheco R. Frecuencia y determinantes de la asfixia perinatal en un servicio especializado de Popayán Colombia 2014. Interdiscip J Epidemiol Public Heal. 2018;1(2):1-8. https://doi.org/10.18041/2665-427x/ijeph.2.5286
16. Departamento Administrativo Nacional de Estadística. Estadísticas Vitales (EEVV): nacimientos en Colombia [internet]. Bogotá; 2021. Disponible en: https://www.dane.gov.co/index.php/estadisticas-por-tema/salud/nacimientos-y-defunciones//
17. Martínez-Biarge M, Madero R, González A, Quero J, García-Alix A. Perinatal morbidity and risk of hypoxic-ischemic encephalopathy associated with intrapartum sentinel events. Am J Obstet Gynecol. 2012;206(2):148.e1-148.e7. https://doi.org/10.1016/j.ajog.2011.09.031
18. Xu EH, Claveau M, Yoon EW, Barrington KJ, Mohammad K, Shah PS, et al. Neonates with hypoxic-ischemic encephalopathy treated with hypothermia: Observations in a large Canadian population and determinants of death and/or brain injury. J Neonatal Perinatal Med. 2020;13(4):459-61.
19. Manotas H, Troncoso G, Sánchez J, Molina G. Descripción de una cohorte de pacientes neonatos con diagnóstico de asfixia perinatal, tratados con hipotermia terapéutica. 2017. Perinatología. 2018;32(2):70-7. https://doi.org/10.1016/j.rprh.2018.07.001
20. Jia W, Lei X, Dong W, Li Q. Benefits of starting hypothermia treatment within 6h vs. 6-12h in newborns with moderate neonatal hypoxic-ischemic encephalopathy. BMC Pediatr. 2018 Feb 12;18(1). https://doi.org/10.1186/s12887-018-1013-2
21. García-Alix A, Arnaez J, Cortés V, Girabent-Farres M, Arca G, Balaguer A. Neonatal hypoxic-ischaemic encephalopathy: most deaths followed end-of-life decisions within three days of birth. Acta Paediatr Int J Paediatr. 2013 Dec 1;102(12):1137-43. https://doi.org/10.1111/apa.12420
22. Armstrong K, Franklin O, Sweetman D, Molloy EJ. Cardiovascular dysfunction in infants with neonatal encephalopathy. Arch Dis Child. 2012;97(4):372-5. https://doi.org/10.1136/adc.2011.214205
23. Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004;89(2):F152-5. https://doi.org/10.1136/adc.2002.023093
24. Szakmar E, Jermendy A, El-Dib M. Respiratory management during therapeutic hypothermia for hypoxic-ischemic encephalopathy. J Perinatol. 2019;39(6):763-73. https://doi.org/10.1038/s41372-019-0349-2
25. Piñeros JG, Troncoso G, Serrano C, Espinosa E. Diagnóstico, manejo, monitoreo y seguimiento del recién nacido con asfixia perinatal, encefalopatía hipóxico isquémica e hipotermia terapéutica [internet]. Bogotá: Asociación Colombiana de Neonatología; 2021. Disponible en: https://ascon.org.co/wp-content/uploads/2021/02/CONSENSO-NEUROLOGIA-Y-NEONATOLOGIA1.pdf
26. Alaro D, Bashir A, Musoke R, Wanaiana L, Bashir A. Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia. Afr Health Sci [internet]. 2014 [citado 2021 may 25];14(3):682-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25352889/
How to Cite
Ramírez-Corredor, A., Devia-Neira, C., Vargas-Vacca, Y. A., Bertolotto-Cepeda, A. M., & Bohórquez-Peñaranda , A. P. (2023). Early Outcomes of Perinatal Asphyxia Management with Cool-Cap®️ and Blanket. Universitas Medica, 64(2). https://doi.org/10.11144/Javeriana.umed64-2.dtma
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