Cooling in mild encephalopathy: Costs and perils of therapeutic creep
File(s)MildHIE_Thayyil Final Revised.docx (182.29 KB)
Accepted version
Author(s)
Kumar, Vijay
Singla, Mani
Thayyil, Sudhin
Type
Journal Article
Abstract
Increasing confidence in therapeutic hypothermia and ambiguity of cooling guidelines has led to many clinicians extending its use to untested populations like mild encephalopathy, or even no encephalopathy. Poor quality clinical neurological examination for encephalopathy staging coupled with a fear of litigation if a baby with mild encephalopathy progress to moderate or severe encephalopathy appears to be the primary driver for this therapeutic creep. Recent data suggesting increased apoptosis with cooling uninjured brains, and lack of hypothermic neuroprotection in partial prolonged hypoxia, implies that such therapeutic creeps may cause more harm than benefit. Currently available preclinical and clinical data do not support the clinical use of therapeutic hypothermia for mild encephalopathy, although phase II clinical trials are ongoing. We recommend that until further evidence from adequately powered randomised controlled trials are available, cooling in mild encephalopathy need to be considered experimental and parental consent should be obtained before providing this therapy.
Date Issued
2021-06-01
Date Acceptance
2021-03-01
Citation
Seminars in Fetal and Neonatal Medicine, 2021, 26 (3)
ISSN
1084-2756
Publisher
Elsevier
Journal / Book Title
Seminars in Fetal and Neonatal Medicine
Volume
26
Issue
3
Copyright Statement
© 2021 Published by Elsevier Ltd. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33849797
PII: S1744-165X(21)00052-4
Subjects
Magnetic resonance imaging
Neonatal encephalopathy
Newborn
Therapeutic hypothermia
Publication Status
Published
Coverage Spatial
Netherlands
Article Number
ARTN 101244
Date Publish Online
2021-04-09