We have yet another new post this year for me to introduce. Dr. Sadia Hussain (of the Trauma Drama series) has teamed up with the wonderful Dr. Ashika Jain to create a Critical Care Mini-Fellowship. We thought it would be useful to your education to write-up a concise review of each meeting.
At our last meeting, along with discussing TEG and numerous other interesting critical care topics, we reviewed this paper: Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy An Updated Systematic Review and Meta-analysis which you can find here. It’s a meta-analysis that identified 7 randomized control trials that evaluated hypothermia in neonates with hypoxic brain injury from 2007 to 2011. In all studies, hypothermia was around 34C and, interestingly, all were compared to a control group of about 37C. All studies excluded patients with congenital abnormalities. Though a few of the studies had the potential for bias, the combined data demonstrated that the hypothermia group had a statistically significant decrease in mortality or major disability, and increase in survival with normal neurologic function at 18 months.
Though meta-analysis can be tricky (heterogeniety, questionable study selection or search criteria), this does have convincing outcomes.
Lesson: Newborn in ED with hypoxic injury – consider hypothermia (Interesting fact 1: Due to their enormous heads, these patients can be cooled with “selective head cooling” alone).
Interesting Fact 2: We’ve all read the two hypothermia studies in adults. One reported:hypothermia works! The second: hypothermia doesn’t work, avoiding fevers works. Here, we have a similar protocols for the second paper with 34C versus 37C and here we have a significant difference. Maybe this makes you think a little about the adult study, or maybe adults…aren’t just large children.
PS Dr. Jain’s lasagna is delicious!
By Dr. Andrew Grock
Tagin MA1, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA.Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis.Arch Pediatr Adolesc Med. 2012 Jun 1;166(6):558-66. doi: 10.1001/archpediatrics.2011.1772.