CONTROLLED HYPOTHERMIA IN COMPLEX THERAPY FOR HYPOXIC ISCHEMIC ENCEPHALOPATHY IN INFANTS WITH BIRTH ASPHYXIA


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Abstract

Objective. To compare the effectiveness of different methods of controlled hypothermia in complex therapy for hypoxic ischemic encephalopathy in infants with birth asphyxia. Materials and methods. The data was collected from 73 birth records and histories of newborns with signs of moderate or severe asphyxia. The newborns were divided into two groups: group I included 46 newborns treated with craniocerebral hypothermia (CCH); group II included 27newborns treated with total hypothermia (TH). Results. During the first hours of life, convulsive activity was observed in 39 (84.8%) and 23 (85.2%) newborns of groups I and II, respectively (p=1.00). According to electroencephalography readings, convulsive activity was confirmed in 33 (84.6%) and 18 (78.3%) infants, respectively (p=0.77). During hypothermia, convulsive activity persisted in 39 (100%) and 4 (17.4%) newborns treated with CCH and TH, respectively (p<0.001). By the end of controlled hypothermia, there was a cessation of convulsions in 11 (28.2%) and 19 (82.6%) newborns treated with CCH and TH, respectively (OR 0.34, 95% CI: 0.23- 0.60), (p<0.001). All the newborns survived and were provided with the second stage of developmental care. Positive dynamics in newborn’s neurological status was observed in 23 (50%) infants of group I and 26 (96.3%) infants of group II at the discharge from hospital after the second stage of developmental care (OR 0.53, 95% CI: 0.49- 0.72, p<0.001); to one year of age dynamics was observed in 9 (28.1%) and 26(96.3%) newborns (OR 0.34, 95% CI: 0.23-0.60, p<0.001), respectively. Conclusion. When CCH and TH are applied in complex therapy for full-term infants with moderate to severe birth asphyxia, they can help prevent the development of severe neurological consequences. TH has advantages over CCH due to the decreased period of newborn’s artificial lung ventilation, faster control of convulsions and favorable outcomes for children during the first year of life.

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About the authors

Galina M. SAVELYEVA

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: gms@cfp.ru
RAS Academician, Doctor of Medical Sciences, professor; Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty Moscow, Russia

Raisa I. SHALINA

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: raisa.shalina@gmail.com
Doctor of Medical Sciences, professor; Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty Moscow, Russia

Aliya A. ANANKINA

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: kuzina.aliya@yandex.ru
Resident of the Department of Obstetrics and Gynecology, Pediatric Faculty Moscow, Russia

Zhanna Yu. KUNYAKH

Centre for Family Planning and Reproduction, Moscow Department of Health

Email: kunzhan2007@rambler.ru
Head of the Intensive Care Unit for Newborns and Premature Infants Moscow, Russia

Lali G. SICHINAVA

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: lalisichinava@gmail.com
Doctor of Medical Sciences, professor; Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty Moscow, Russia

Yulia V. SOKOLOVSKAYA

Clinical Hospital Lapino, Group of Companies "Mother and Child"

Email: y.sokolovskaya@mcclinics.ru
PhD; Head of Intensive Care Unit for Newborns Moscow Region, Russia

Dmitrii S. SPIRIDONOV

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: spiridonov_ds@rsmu.ru
PhD; Associate professor of the Department of Obstetrics and Gynecology, Pediatric Faculty Moscow, Russia

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