Hypothermia has been proposed as a neuroprotective strategy. However, short-term cooling after hypoxia-ischemia is effective only if started immediately during resuscitation. The aim of this study was to determine whether prolonged head cooling, delayed into the late postinsult period, improves outcome from severe ischemia. Unanesthetized near term fetal sheep were subject to 30 min of cerebral ischemia. 90 min later they were randomized to either cooling (n = 9) or sham cooling (n = 7) for 72 h. Intrauterine cooling was induced by a coil around the fetal head, leading initially to a fall in extradural temperature of 5-10 degrees C, and a fall in esophageal temperature of 1.5-3 degrees C. Cooling was associated with mild transient systemic metabolic effects, but not with hypotension or altered fetal heart rate. Cerebral cooling reduced secondary cortical cytotoxic edema (P < 0.001). After 5 d of recovery there was greater residual electroencephalogram activity (-5.2+/-1.6 vs. -15.5+/-1.5 dB, P < 0.001) and a dramatic reduction in the extent of cortical infarction and neuronal loss in all regions assessed (e.g., 40 vs. 99% in the parasagittal cortex, P < 0.001). Selective head cooling, maintained throughout the secondary phase of injury, is noninvasive and safe and shows potential for improving neonatal outcome after perinatal asphyxia.
A J Gunn, T R Gunn, H H de Haan, C E Williams, P D Gluckman
Title and authors | Publication | Year |
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Analysis of Neuronal, Glial, Endothelial, Axonal and Apoptotic Markers Following Moderate Therapeutic Hypothermia and Anesthesia in the Developing Piglet Brain
P Gressens, J Dingley, F Plaisant, H Porter, L Schwendimann, C Verney, J Tooley, M Thoresen |
Brain Pathology | 2008 |
Sustained depression of brainstem auditory electrophysiology during the first months in term infants after perinatal asphyxia
ZD Jiang, DM Brosi, XM Shao, AR Wilkinson |
Clinical Neurophysiology | 2008 |
Strategies for the management of neonatal hypoxic–ischemic brain injury
JM Perlman |
Expert Review of Obstetrics & Gynecology | 2008 |
Post-resuscitation strategies to avoid ongoing injury following intrapartum hypoxia–ischemia
A Stola, J Perlman |
Seminars in Fetal and Neonatal Medicine | 2008 |
Therapeutics for neonatal brain injury
FF Gonzalez, DM Ferriero |
Pharmacology & Therapeutics | 2008 |
Extracellular amino acids and lipid peroxidation products in periventricular white matter during and after cerebral ischemia in preterm fetal sheep
M Fraser, L Bennet, PL van Zijl, TJ Mocatta, CE Williams, PD Gluckman, CC Winterbourn, AJ Gunn |
Journal of Neurochemistry | 2008 |
Brain-regulated metabolic suppression during hibernation: a neuroprotective mechanism for perinatal hypoxia–ischemia
TI Nathaniel |
International Journal of Stroke | 2008 |
A review of selective hypothermia in the management of traumatic brain injury
E Christian, G Zada, G Sung, SL Giannotta |
Neurosurgical FOCUS | 2008 |
Therapeutic hypothermia in neonates. Review of current clinical data, ILCOR recommendations and suggestions for implementation in neonatal intensive care units
T Hoehn, G Hansmann, C Bührer, G Simbruner, AJ Gunn, J Yager, M Levene, SE Hamrick, S Shankaran, M Thoresen |
Resuscitation | 2008 |
Cochrane Review: Cooling for newborns with hypoxic ischaemic encephalopathy
SE Jacobs, R Hunt, WO Tarnow-Mordi, TE Inder, PG Davis |
Evidence-Based Child Health: A Cochrane Review Journal | 2008 |
Delayed Hypothermia as Selective Head Cooling or Whole Body Cooling Does Not Protect Brain or Body in Newborn Pig Subjected to Hypoxia-Ischemia
M Karlsson, JR Tooley, S Satas, CE Hobbs, E Chakkarapani, J Stone, H Porter, M Thoresen |
Pediatric Research | 2008 |
Hypothermia Therapy for Cardiac Arrest in Pediatric Patients
JS Hutchison, DR Doherty, JP Orlowski, N Kissoon |
Pediatric Clinics of North America | 2008 |
Hypothermia for Hypoxic-Ischemic Encephalopathy
R Sahni, UM Sanocka |
Clinics in Perinatology | 2008 |
Neonatology: Questions and Controversies Series: Neurology
AR Laptook |
Neonatology: Questions and Controversies Series: Neurology | 2008 |
The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: A randomised controlled trial
D Azzopardi, P Brocklehurst, D Edwards, H Halliday, M Levene, M Thoresen, A Whitelaw |
BMC Pediatrics | 2008 |
Selective hypothermia: an experimental study on traumatic brain injury in rats
AE Dvilevicius, MN Prandini |
Arquivos de Neuro-Psiquiatria | 2008 |