A Contrast Study On Different Time Window To Starting Mild Hypothermia Treatment On The Neonatal Hypoxic-Ischemic Encephalopathy

Background:HIE is still an important reason of the neonatal death in the perinatal period and neurodevelopmental abnormalities in the late.As its etiology is complex, the most key link of pathogenesis of is the occurrence of secondary energy failure, especially the late-onset energy failure.The latter may initiate a series of biochemical cascade "waterfall" type, cause or aggravate neuron death in the end. Secondary energy failure after 6 ~ 12 h, the stage provides a disease intervention time window.Clinical multicenter studies currently suggest that the low temperature treatment can significantly improve the prognosis of HIE children with moderately and severely.6 h after birth is a treatment time window. But some scholars think it is equally effective to delay start time of low temperature treatment to within 10 h after hypoxia ischemia. The report of time window delaying to 10 or 12 h is quite a less,While there are more children which > 6 h after hypoxic ischemic brain damagement were admitted to hospital clinically.Especially in the western China where medical technology is relatively backward and economy or transportation in the less developed area.If low temperature treatment was delayed to 6 h after birth,it will benefit for within 6 h of missing the best treatment time window of HIE children.Studies have shown that SarnatⅠdegree(mild) of children with HIE is associated with poorly cognitive function in childhood.Children’s cognitive and memory score of Sarnat Ⅰdegree is lower than normal group.So whether children with mild HIE will be benefitted by low temperature treatment also needs more and large sample research.Particularly, it is very difficult to evaluate the severity of HIE early after birth according to the objective indicators,Low temperature treatment only for moderate and severe HIE children will miss some children who may be benefitted.Therefore, whether giving up children which > 6 h hospitalized after hypoxic ischemic brain damagement of HIE and whether giving low temperature treatment to children seen as mild HIE still worth exploring.Objective: to study the clinical effects of different time window to starting mild hypothermia treatment on the neonatal hypoxic-ischemic encephalopathy by observing a EEG and NSE level changes and cerebral glucose metabolism rate changes of 18 f- FDG PET before and after therapy.Methods : Choose thsoe newborns that accord with pediatrics of Chinese medical association branch of the newborn group revision the HIE diagnostic criteria in 2005 and live in neonatology department in August 2013 to August 2014. According to the principle of informed consent with the mild hypothermia and regular treatment.According to the starting time of treatment were divided into 6 h group and 6 to 12 hours group. And according to the condition were divided into mild and moderately severe groups.In the end, there were 129 cases of newborns with HIE can be included in the statistics of effective cases. The group of 63 cases in low temperature(the mild 31 cases: < 6 h 15 cases, 6 and 12 h group 16 cases;the moderately severe 32 cases: < 6 h group 21 cases, 6 and 12 h 11). there are 66 cases in matched group(the mild 32 cases: < 6 h group 18 cases, 6 and 12 h 14 cases; the moderately severe 34 cases: < 6 h group 20 cases, 6 and 12 h 14 cases).The differences had no statistical significance of the sex, birth weight and gestational age of each newborn(P>0.05),it is has comparability.Normal group was treated by classical solutions, mild hypothermia group on the basis of conventional treatment combined with head mild hypothermia therapy.All the newborns with a EEG monitoring and NSE measuring and cerebral glucose metabolism rate changes of 18 f- FDG PET before and after 3 days treatment.Results: before the treatment of newborns with HIE, a EEG and NSE and cerebral glucose metabolism rate of each brain area change along with the degree of disease within the same time window. The a EEG scroe and the SUV scroe of each brain area of Children with moderately severe HIE is higher than mild HIE,the NSE is lower than mild HIE(P<0.05). Whether it is within 6 h or 6 to 12 h starting mild hypothermia therapy for mild HIE newborns, it is all have obvious change for a EEG and NSE and SUV scroe of each brain area compared with control group. The a EEG scroe and the SUV scroe of each brain area of Children with mild hypothermia is higher than control group,the NSE is lower than control group(P<0.05).However,it is only within 6 h starting mild hypothermia therapy for moderately severe HIE newborns, it is have obvious change for a EEG and NSE and SUV scroe compared with control group(P<0.05),it is not for 6 to 12 h(P>0.05).Conclusions: a EEG and NSE Can be used as a monitoring of newborns with HIE severity and objective indexes of recent curative effects.The 18 f- FDG PET imaging gradually starting can also be used for new chil dren with HIE In recent years. By detecting cerebral glucose metabolism rate, we can objective evaluation the severity of brain damage of Childr en with HIE. Our research shows that, brain function monitoring, bioche mical index NSE detection and imaging of 18 f- FDG PET imaging in three different testing means can be confirmed it is effective for newborn s with moderately severe HIE to accept mild hypothermia treatment after born within 6 hours, but the effect is not significant to accept mild hyp othermia treatment after 6 hours. It is still effective to accept mild hyp othermia treatment for newborns with mild HIE within 12 hours after bir th. Although the long-term curative effect needs further research,but sug gested that children with mild HIE treatment is still feasible, to minimize the omissions may benefit from children.