Unanswered questions regarding therapeutic hypothermia for neonates with neonatal encephalopathy

Therapeutic hypothermia (TH) is now well established to improve intact survival after neonatal encephalopathy (NE). However, many questions could not be addressed by the randomized controlled trials. Should late preterm newborns with NE be cooled? Is cooling beneficial for mild NE? Is the current th...

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Published in:Seminars in fetal & neonatal medicine 2021-10, Vol.26 (5), p.101257-101257, Article 101257
Main Authors: Sabir, Hemmen, Bonifacio, Sonia L., Gunn, Alistair J., Thoresen, Marianne, Chalak, Lina F.
Format: Article
Language:English
Subjects:
Female
Humans
Hypothermia, Induced
Hypoxia-ischemia
Hypoxia-Ischemia, Brain - therapy
Infant, Newborn
Infant, Newborn, Diseases - therapy
Infection
Neonatal encephalopathy
Newborn
Pregnancy
Therapeutic hypothermia
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Summary:Therapeutic hypothermia (TH) is now well established to improve intact survival after neonatal encephalopathy (NE). However, many questions could not be addressed by the randomized controlled trials. Should late preterm newborns with NE be cooled? Is cooling beneficial for mild NE? Is the current therapeutic time window optimal, or could it be shortened or prolonged? Will either milder or deeper hypothermia be effective? Does infection/inflammation exposure in the perinatal period in combination with NE offer potentially beneficial preconditioning or might it obviate hypothermic neuroprotection? In the present review, we dissect the evidence, for whom, when and how can TH best be delivered, and highlight areas that need further research.
ISSN:1744-165X
1878-0946
DOI:10.1016/j.siny.2021.101257