Background: Therapeutic hypothermia for neonates with Hypoxic Ischemic Encephalopathy (HIE) has been shown to reduce cerebral injury and disabilities. The cooling on transport can minimize delay in treatment. This paper is to study the feasibility and effect of the cooling on transport and therapeutic hypothermia for neonates with HIE.
Methods: The enrolled neonates with HIE were hospitalized in our hospital form July 2013 to June 2016 and divided into group A (Be admitted to hospital by cooling transfer, initiation of therapeutic hypothermia < 6 hr after birth), group B (Be admitted to hospital by cooling transfer, initiation of therapeutic hypothermia 6-12 hr after birth), group C (Born in our hospital, initiation of therapeutic hypothermia < 6 hr after birth) and the control group (without therapeutic hypothermia). The survival rate and neurodevelopment outcomes were analyzed in each group.
Results: The survival rate in group A (93%), in group B (90%), and in group C (88%) were higher than that in control group (63%). (All values of P < 0.05). The score of neonatal behavioral neurological assessment in group A (36.2 ± 1.7), in group B (90%) and in group C (88%) were higher than those in control group (63%). (All values of P < 0.05). The incidence rate of neurodevelopmental retardation, cerebral palsy and mental retardation in group A (25%, 19%, 19%), in group B (10%, 7%, 10%) and in group C (7%, 8%, 8%) were lower than those in control group (100%, 100%, 88%). (All values of P < 0.05). There was no statistically significant difference in those among group A, group B and group C. (All values of P > 0.05). Conclusions: Therapeutic hypothermia might be extended to peripheral hospitals through cooling on transport and start within the first 12 hr after birth. The cooling on transport and therapeutic hypothermia is a useful and safe treatment method for neonates with HIE.
Therapeutic hypothermia is a neuroprotective technique indicated for neonates with perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE). To be effective, early initiation of hypothermia therapy is critical.  The neuroprotective strategy of therapeutic hypothermia involves the modulation of some irreversible injury mechanisms, such as inflammatory cascade inhibition, reduced production of reactive oxygen species, and reduction in the metabolic rate with reduced oxygen consumption and carbon dioxide production, and an endogenous neuroprotective effect [2-4]. HIE is characterized by two phases of injury, a primary and secondary phase of energy failure, separated by a short recovery phase. The recovery period may last between 6 and 15 hours. Once the recovery phase has ended, the secondary phase of injury occurs; abnormal pathways of energy use result in free radicals and finally complex energy failure that ultimately causes irreversible neuronal injury [5-7]. It is important to start hypothermia therapy before the secondary phase, during the therapeutic window of opportunity when apoptotic neurons are able to recover. However, there are many hospitals do not offer this hypothermia therapy. So, immediate identification and intervention at the birth hospital are critical and transport to a regional center is necessary. Cooling therapy, when initiated at the place of birth and continued on transport to Neonatal Intensive Care Units (can offer the hypothermia therapy), minimizes delay in treatment . The aim of this study was to observe the feasibility and effect of the cooling on transport and therapeutic hypothermia for neonates with HIE.