Childhood outcomes after hypothermia for neonatal encephalopathy
Seetha Shankaran, Athina Pappas, Scott A McDonald, Betty R Vohr, Susan R Hintz, Kimberly Yolton, Kathryn E Gustafson, Theresa M Leach, Charles Green, Rebecca Bara, Carolyn M Petrie Huitema, Richard A Ehrenkranz, Jon E Tyson, Abhik Das, Jane Hammond, Myriam Peralta-Carcelen, Patricia W Evans, Roy J Heyne, Deanne E Wilson-Costello, Yvonne E Vaucher, Charles R Bauer, Anna M Dusick, Ira Adams-Chapman, Ricki F Goldstein, Ronnie Guillet, Lu-Ann Papile, Rosemary D Higgins, Eunice Kennedy Shriver NICHD Neonatal Research Network, Alan H Jobe, Michael S Caplan, Abbot R Laptook, William Oh, Angelita M Hensman, Lucy Noel, Victoria E Watson, Michele C Walsh, Avroy A Fanaroff, Nancy Bass, Harriet G Friedman, Nancy S Newman, Bonnie S Siner, Kurt Schibler, Edward F Donovan, Kate Bridges, Jean J Steichen, Barbara Alexander, Cathy Grisby, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, C Michael Cotten, Kathryn E Gustafson, Kathy J Auten, Katherine A Foy, Kimberley A Fisher, Sandy Grimes, Melody B Lohmeyer, Barbara J Stoll, David P Carlton, Lucky Jain, Ann M Blackwelder, Ellen C Hale, Sobha Fritz, Linda L Wright, Elizabeth M McClure, Stephanie Wilson Archer, Brenda B Poindexter, James A Lemons, Diana D Appel, Jessica Bissey, Dianne E Herron, Lucy C Miller, Leslie Richard, Leslie Dawn Wilson, W Kenneth Poole, Jeanette O'Donnell Auman, Margaret Cunningham, Betty K Hastings, Jamie E Newman, Scott E Schaefer, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, M Bethany Ball, Maria Elena DeAnda, Waldemar A Carlo, Namasivayam Ambalavanan, Kathleen G Nelson, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Laurie Lou Smith, Martha G Fuller, Radmila West, Neil N Finer, David Kaegi, Maynard R Rasmussen, Kathy Arnell, Chris Henderson, Wade Rich, Shahnaz Duara, Sylvia Hiriart-Fajardo, Mary Allison, Maria Calejo, Ruth Everett-Thomas, Silvia M Frade Eguaras, Susan Gauthier, Dale L Phelps, Gary J Myers, Diane Hust, Linda J Reubens, Pablo J Sánchez, R Sue Broyles, Abbot R Laptook, Charles R Rosenfeld, Walid A Salhab, Roy J Heyne, Cathy Boatman, Cristin Dooley, Gaynelle Hensley, Jackie F Hickman, Melissa H Leps, Susie Madison, Nancy A Miller, Janet S Morgan, Lizette E Torres, Alicia Guzman, Jon E Tyson, Kathleen A Kennedy, Esther G Akpa, Patty A Cluff, Claudia I Franco, Anna E Lis, Georgia E McDavid, Patti L Pierce Tate, Nora I Alaniz, Pamela J Bradt, Magda Cedillo, Susan Dieterich, Patricia W Evans, Charles Green, Margarita Jiminez, Terri Major-Kincade, Brenda H Morris, M Layne Poundstone, Stacey Reddoch, Saba Siddiki, Maegan C Simmons, Laura L Whitely, Sharon L Wright, Lourdes M Valdés, Yvette R Johnson, Laura A Goldston, Geraldine Muran, Deborah Kennedy, Patrick J Pruitt, Patricia Gettner, Monica Konstantino, JoAnn Poulsen, Elaine Romano, Joanne Williams, Susan DeLancy, Seetha Shankaran, Athina Pappas, Scott A McDonald, Betty R Vohr, Susan R Hintz, Kimberly Yolton, Kathryn E Gustafson, Theresa M Leach, Charles Green, Rebecca Bara, Carolyn M Petrie Huitema, Richard A Ehrenkranz, Jon E Tyson, Abhik Das, Jane Hammond, Myriam Peralta-Carcelen, Patricia W Evans, Roy J Heyne, Deanne E Wilson-Costello, Yvonne E Vaucher, Charles R Bauer, Anna M Dusick, Ira Adams-Chapman, Ricki F Goldstein, Ronnie Guillet, Lu-Ann Papile, Rosemary D Higgins, Eunice Kennedy Shriver NICHD Neonatal Research Network, Alan H Jobe, Michael S Caplan, Abbot R Laptook, William Oh, Angelita M Hensman, Lucy Noel, Victoria E Watson, Michele C Walsh, Avroy A Fanaroff, Nancy Bass, Harriet G Friedman, Nancy S Newman, Bonnie S Siner, Kurt Schibler, Edward F Donovan, Kate Bridges, Jean J Steichen, Barbara Alexander, Cathy Grisby, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, C Michael Cotten, Kathryn E Gustafson, Kathy J Auten, Katherine A Foy, Kimberley A Fisher, Sandy Grimes, Melody B Lohmeyer, Barbara J Stoll, David P Carlton, Lucky Jain, Ann M Blackwelder, Ellen C Hale, Sobha Fritz, Linda L Wright, Elizabeth M McClure, Stephanie Wilson Archer, Brenda B Poindexter, James A Lemons, Diana D Appel, Jessica Bissey, Dianne E Herron, Lucy C Miller, Leslie Richard, Leslie Dawn Wilson, W Kenneth Poole, Jeanette O'Donnell Auman, Margaret Cunningham, Betty K Hastings, Jamie E Newman, Scott E Schaefer, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, M Bethany Ball, Maria Elena DeAnda, Waldemar A Carlo, Namasivayam Ambalavanan, Kathleen G Nelson, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Laurie Lou Smith, Martha G Fuller, Radmila West, Neil N Finer, David Kaegi, Maynard R Rasmussen, Kathy Arnell, Chris Henderson, Wade Rich, Shahnaz Duara, Sylvia Hiriart-Fajardo, Mary Allison, Maria Calejo, Ruth Everett-Thomas, Silvia M Frade Eguaras, Susan Gauthier, Dale L Phelps, Gary J Myers, Diane Hust, Linda J Reubens, Pablo J Sánchez, R Sue Broyles, Abbot R Laptook, Charles R Rosenfeld, Walid A Salhab, Roy J Heyne, Cathy Boatman, Cristin Dooley, Gaynelle Hensley, Jackie F Hickman, Melissa H Leps, Susie Madison, Nancy A Miller, Janet S Morgan, Lizette E Torres, Alicia Guzman, Jon E Tyson, Kathleen A Kennedy, Esther G Akpa, Patty A Cluff, Claudia I Franco, Anna E Lis, Georgia E McDavid, Patti L Pierce Tate, Nora I Alaniz, Pamela J Bradt, Magda Cedillo, Susan Dieterich, Patricia W Evans, Charles Green, Margarita Jiminez, Terri Major-Kincade, Brenda H Morris, M Layne Poundstone, Stacey Reddoch, Saba Siddiki, Maegan C Simmons, Laura L Whitely, Sharon L Wright, Lourdes M Valdés, Yvette R Johnson, Laura A Goldston, Geraldine Muran, Deborah Kennedy, Patrick J Pruitt, Patricia Gettner, Monica Konstantino, JoAnn Poulsen, Elaine Romano, Joanne Williams, Susan DeLancy
Abstract
Background: We previously reported early results of a randomized trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy showing a significant reduction in the rate of death or moderate or severe disability at 18 to 22 months of age. Long-term outcomes are now available.
Methods: In the original trial, we assigned infants with moderate or severe encephalopathy to usual care (the control group) or whole-body cooling to an esophageal temperature of 33.5°C for 72 hours, followed by slow rewarming (the hypothermia group). We evaluated cognitive, attention and executive, and visuospatial function; neurologic outcomes; and physical and psychosocial health among participants at 6 to 7 years of age. The primary outcome of the present analyses was death or an IQ score below 70.
Results: Of the 208 trial participants, primary outcome data were available for 190. Of the 97 children in the hypothermia group and the 93 children in the control group, death or an IQ score below 70 occurred in 46 (47%) and 58 (62%), respectively (P=0.06); death occurred in 27 (28%) and 41 (44%) (P=0.04); and death or severe disability occurred in 38 (41%) and 53 (60%) (P=0.03). Other outcome data were available for the 122 surviving children, 70 in the hypothermia group and 52 in the control group. Moderate or severe disability occurred in 24 of 69 children (35%) and 19 of 50 children (38%), respectively (P=0.87). Attention-executive dysfunction occurred in 4% and 13%, respectively, of children receiving hypothermia and those receiving usual care (P=0.19), and visuospatial dysfunction occurred in 4% and 3% (P=0.80).
Conclusions: The rate of the combined end point of death or an IQ score of less than 70 at 6 to 7 years of age was lower among children undergoing whole-body hypothermia than among those undergoing usual care, but the differences were not significant. However, hypothermia resulted in lower death rates and did not increase rates of severe disability among survivors. (Funded by the National Institutes of Health and the Eunice Kennedy Shriver NICHD Neonatal Research Network; ClinicalTrials.gov number, NCT00005772.).
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Source: PubMed