Evaluation Of The Effect Of Whole Body Mild Hypothermia At Different Time Windows In The Treatment Of Neonatal Hypoxic-ischemic Encephalopath

Objective: To compare the effects of clinical and amplitude-integrated electroencephalogram(a EEG)in neonates with hypoxic-ischemic encephalopathy(HIE)at gestational age ≥36 weeks under different time windows(within 6 hours after birth and 6-12 hours after birth)treated with systemic sub-hypothermia,to provide a possible basis for the effectiveness of treating HIE with systemic sub-hypothermia at 6-12 hours after birth.Methods: A clinical trial was conducted between January 2017 and December 2019,and 36 cases of infants diagnosed HIE were enrolled.According to whether the starting time of systemic sub-hypothermia treatment exceeded 6h or not,19 cases were divided into the 6h group(Group A)and 17 cases were divided into the 6-12 h group(Group B).The two groups were given systemic sub-hypothermia after their families signed the informed consent for hypothermia.In the meantime,monitoring vital signs,hepatorenal function,myocardial enzymes,electrolytes,coagulation routine,amplitude-integrated encephalogram(a EEG)at 20 minutes before hypothermia,72 hours after treatment and 7 days after birth,and completing neonatal behavioral neurological assessment at 7 and 28 days after birth in both groups,respectively.Results: 1.The clinical classification of newborns with HIE in both groups was mainly moderate and severe encephalopathy,there was no significant difference(P>0.05)in gender,gestational age,birth weight,PH value and BE value(absolute value)of umbilical artery blood gas,Apgar score,seizure rate,incidence of respiratory failure between two groups;2.There was no significant difference in a EEG score between the two groups at 20 minutes before sub-hypothermia treatment,72 hours after treatment and 7 days after birth,respectively(P>0.05).At the same time,The a EEG scores of each group were significantly different during the three measurements,and all the a EEG scores of each groups after mild hypothermia treatment for 72 hours and 7 days after birth were significantly higher than before,showing statistical significance(P <0.05).3.There was no significant difference in the incidence of outbreak inhibition potential between the two groups of HIE newborns in the two periods of 20 minutes before sub-hypothermia treatment and 72 hours after treatment(P>0.05);4.There was no significant difference in the incidence of continuous point voltage between the two groups of HIE newborns in the two periods of 20 minutes before sub-hypothermia treatment and 72 hours after treatment(P>0.05);5.There was no significant difference in the incidence of equipotential between the two groups of HIE newborns in the two periods of 20 minutes before sub-hypothermia treatment and 72 hours after treatment(P>0.05);6.There was a significant delay in the occurrence of mature Sleep-wake cycle(SWC)in the treatment group(6-12 h group)compared with the control group,and the difference was statistically significant(P <0.05).7.Compared with the control group,the NBNA scores of patients in the treatment group at 7d and 28 d after birth severally,showed no significant difference(P> 0.05).And the NBNA scores of newborns with HIE at 28 d after birth were significantly higher than those at 7d after birth in both group,and the difference was statistically significant(P <0.05).Conclusion:Systemic sub-hypothermia therapy for HIE started within 6 h and 6-12 h after birth has similar protective effects on the brain,the earlier the treatment is started,the better the therapeutic effect will be.