A Clinic Study Of Systemic Mild Hypothermia Treatment On Different Time Window To Start On The Neonatal Hypoxic-ischemic Encephalopathy

Objective:To explore the efficiency and safety of systemic mild hypothermia treatment on different time window to start on the neonatal hypoxic-ischemic encephalopathy.Methods:From January 2013 to August 2018,all term infants within 12 hours after birth who were admitted in neonatal intensive care unit in hunan children’s hospital with the diagnosis of neonatal hypoxic ischemic encephalopathy were included.According to the treatment given,all infants divided into 3 groups,hypothermia treatment within 6 hours after birth(TH1),hypothermia treatment between 6-12 hours after birth(TH2)and Control Group.Clinical data and follow-up data at 6 months were collected and analysised.Results:1.A total of 147 children were enrolled,with 110 males(75%)and 37 females(25%);gestational age ranging from 39.5±1.2 weeks;birth weight(3375.8±467.1)g.111cases(75.7%)were treated with systemic hypothermia on different start time window for 72 hours,TH1 79 cases(53.7%),TH2 32 cases(21.8%);while 36 cases(24.5%)had normal treatment except hypothermia.Clinic data of the three groups were compared,including gestational age,birth weight,fetal distress,gender,rate of intubation resuscitation,premature rupture of membranes,delivery mode,Apgar 1-minute score,and other differences were not statistically significant.2.There were no significant differences in the incidence of adverse reactions such as 72-hour bradycardia,pulmonary hypertension,thrombocytopenia,coagulopathy,electrolyte imbalance,liver and kidney function and skin damage in the three groups(P>0.05).There were no severe embolisms in all of the patients in this study.One patient in the TH1 group had severe hypotension(mean arterial pressure <35 mmHg)..3.The enrolled children completed NBNA examination about 10 days after birth.The NBNA scores of the three groups were compared,H=6.277,P=0.043.The difference was statistically significant.Further comparison with LSD showed that children in TH1 group The NBNA score was higher than that of the control group,P=0.047.There was no significant difference in NBNA score between the TH2 group and the TH1 group and the control group.The children enrolled in the brain completed MRI examination about 7 days after birth.The MRI injuries of the brain in the three groups were compared,H=9.501,P=0.01,the difference was statistically significant.Compared with the control group,the children in the TH1 group had a milder MRI injury,P=0.01.In the TH2 group,the MRI of the brain was also less severe than the control group,P=0.038;the TH1 group and the TH2 group suffered from the injury.There was no significant difference in the degree of MRI injury in the brain.There were no significant differences in fundus and BAEP between the three groups.4.A total of 100 children survived and were followed up for 6 months after enrollment.There were no blind or deaf children.The MDI scores of the three groups were statistically different at 6 months,H=8.516,P=0.014;the MDI score of the children in the TH1 group was higher than that of the control group,P=0.03;the MDI score of the children in the TH2 group was higher than that of the control group.Group,P=0.02;there was no significant difference in MDI scores between children in TH1 group and TH2 group.There were no significant differences in PDI scores between the three groups at 6 months.A total of 21 patients(21%)had neurodevelopmental abnormalities,of which 26.3% were in the control group,higher than those in the TH1 group(21.1%)and TH2(16.7%),but the differences between the three groups were not statistically significant.(P>0.05).The mortality rate of the control group at 6 months after birth(32.1%)was higher than that of the TH1 group(6.6%),P<0.05;the mortality of the control group was compared with the TH2 group,the TH1 group and the TH2 group.There was no statistical difference.The study was lost to 31 patients(21.1%)at 6 months,but there was no statistical difference between the follow-up children and the patients who were lost to follow-up.The results have certain reference value.Conclusion: 1.Systemic hypothermia treatment of children with HIE is safe,prolong the treatment time window to 6-12 hours will not increase the incidence of adverse reactions.2.Prolonging the systemic hypothermia treatment time window to 6-12 hours after birth is still effective,can improve the death and neurodevelopmental outcome of children with HIE to some extent.