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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Birth asphyxia is frequent and often severe, occurring in about 10% and 1% respectively of all births; in a third it is unexpected. Delivery rooms must be organised and equipped and trained staff readily available so as to provide appropriate and timely resuscitation of the newborn. Simple procedures designed to prevent hypothermia, maintain a patent airway, improve oxygenation and ventilation are sufficient for the majority of babies. Circulatory support and biochemical resuscitation will be needed in a few. In the absence of other abnormalities, the long term prognosis for newborns who respond promptly to resuscitation is good. Every baby, no matter how severely asphyxiated must therefore be promptly and vigorously resuscitated. Only those with a Apgar score of less than 4 at 10 minutes, prolonged hypotonia or seizures have a poor prognosis. With the needs in cardio-pulmonary resuscitation understood and met, research is now being directed at neuroresuscitation.
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PMID:Resuscitation at birth. 237 83

Deliveries outside of maternity hospitals in 1983 resulted in many high risk newborns. In 40% of cases it occurred in lower socio-economic groups and in 60% was due to lack of information with regards to recent progress in obstetrical care. The presence of regional emergency services (SAMU) and competent pediatric care, has allowed for rapid transport and medical intervention. One hundred and fifty newborns weighing between 850 and 3,790 gms were thus transported: 50% were of low birth weight, 63% born after 38 weeks gestation and 37% were premature. Hypothermia was common and details of labour were unknown. Despite rapid intervention, there were 9 deaths including 6 with severe neonatal asphyxia. Morbidity was related to socio-economic and intellectual parental levels.
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PMID:[Deliveries outside maternity hospitals. 5-year prospective study apropos of 150 cases]. 380 May 65

Perinatal asphyxia remains one of the most devastating neurologic processes. Although the understanding of the pathophysiology after perinatal asphyxia is extensive, there are few therapeutic interventions available to prevent or even mitigate the devastating process that unfolds after injury. The search for a safe and efficacious therapy has prompted scientists and clinicians to consider various promising therapies. One such therapy is therapeutic hypothermia. On the basis of adult, pediatric, and animal research, there is increasing evidence to suggest that therapeutic hypothermia may be an effective intervention to lessen the secondary neuronal injury that ensues after a hypoxic-ischemic insult. In this article the historic and modern-day uses of therapeutic hypothermia are first reviewed. The pathophysiology of neonatal asphyxia is examined next, with emphasis on the changes that occur when therapeutic hypothermia is implemented. Potential side-effects of the therapy in the neonate and the debate over systemic vs selective hypothermia are discussed. Lastly, although hypothermia as a potential treatment modality for neonates with hypoxic-ischemic encephalopathy is supported by numerous studies, the need for well-designed multicenter trials with detailed patient entry criteria and therapeutic conditions is emphasized.
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PMID:The use of hypothermia: a role in the treatment of neonatal asphyxia? 1042 27

During the study period there were 2063 live births. Of these 573 (27.8%) were low birth weight (LBW), 277 (13.4%) preterm and 148 (7.1%) small for date (SFD) babies. In all, 263 (12.7%) newborns suffered from one or the other morbidity. Birth asphyxia of varying severity developed in 130 (6.3%) babies [88 LBW and 42 normal birth weight (NBW) (p < 0.001)]. Respiratory distress syndrome was diagnosed in 82 (3.9%) babies, most being due to hyaline membrane diseases (31.7%), which affected 26 (9.4%) of preterm babies. Deep infections were seen in 109 (5.3%) newborns [60 LBW and 49 NBW, (p < 0.001)] and superficial infections were seen in 79 (3.8%) babies [46 LBW and 33 NBW, (p < 0.001)]. Hyperbilirubinemia was detected in 78 (3.8%) babies. In one fifth of the babies, the cause of hyperbilirubinemia remained unidentified even after detailed investigations. Hypothermia was observed in 59 (2.9%) newborns [48 LBW and 11 NBW, (p < 0.001] and congenital malformations were seen in 24 (1.7%) babies. Morbidity was found to be high amongst LBW and preterm babies. The incidence of deep infections and hypothermia was high in our study.
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PMID:Neonatal morbidity in a hospital at Shimla. 1079 31

The incidence and correlates of low birth weight (LBW) among an index population of 525 newborn Nigerian twins and a control population of 363 singletons were studied. The incidence of LBW among the twins (53.9%) was significantly higher than the incidence of 11.8% among the singletons (P < 0.001). Smallness for gestational age (SGA) was also higher (14.3%) among the twins compared with 1.4% among the singletons (P < 0.001). Morbidity factors frequently associated with LBW among the twins were perinatal asphyxia, hypothermia, neonatal seizures, and intracranial haemorrhage. Intrapartum asphyxia was particularly common in those preterm LBW twins who were also SGA. This raises serious concern because of the known higher risks of SGA preterm babies for severe neurologic sequelae. Low socioeconomic status (SES) of mothers was an important predisposing factor to LBW and SGA as well as to premature deliveries among the twins. Improved SES of the maternal population and increased awareness by health practitioners of the risks LBW twins face, should improve their immediate and later outcome. Furthermore, there is a need for the development of an intrauterine growth chart for Nigerian twins to enhance accurate diagnosis of LBW and SGA among newborn twins.
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PMID:Low birth weight and its correlates among Nigerian twins. 1089 19

Therapeutic hypothermia is a potentially dangerous treatment with a very narrow therapeutic index. It is of proven benefit in certain conditions, including post ventricular fibrillation cardiac arrest and intermediate severity neonatal asphyxia. It is of no benefit and may cause harm in other contexts, such as elective neurovascular surgery. In traumatic brain injury there has been much provocative early evidence. While it is clear that hypothermia decreases intracranial pressure, a major phase III trial demonstrated no improvement in neurological outcomes with hypothermia, in an unselected group of patient with severe head injury. More focused phase III trials are underway but until the results are known this treatment should not be offered to patients outside the context of a clinical trial.
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PMID:Hypothermia does not improve outcome from traumatic brain injury. 1654 51

Therapeutic hypothermia has been used for millennia, but in recent years was not in much clinical use due to an apparent high risk of complications. More recently, the benefits of induced therapeutic hypothermia have been rediscovered, mainly with the improvement in neurological outcome in out-of-hospital cardiac arrest victims. In addition, therapeutic hypothermia has been suggested to improve outcome in other neurological conditions such as traumatic brain injury, neonatal asphyxia, cerebrovascular accidents and intracranial hypertension. This article reviews the history of the discovery of therapeutic hypothermia, as well as the current therapeutic applications and ways to deliver this treatment. Cooling techniques and recovery processes, as well as potential complications are also reviewed. Clinicians caring for a wide variety of critically ill patients should be familiar with the use of therapeutic hypothermia.
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PMID:Therapeutic hypothermia. 1693 Aug 1

Deliberate mild hypothermia was first used in 1955 as an intraoperative technique to ameliorate new neurological deficits following cerebral aneursym clipping, and subsequently was also used following neonatal asphyxia, head trauma and cardiac arrest. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST II) randomized control trial was designed to determine the effectiveness of mild hypothermia to decrease neurological deficits following aneurysm surgery. No overall benefit was demonstrated in the hypothermic group versus normothermic group (67% versus 63% good outcome; p=0.32), with a higher rate of bacteraemia in the hypothermic group (5% versus 3%; p=0.05). We undertook a survey of Australasian and Asian neuroanaesthetists to determine whether their thermal management of patients undergoing cerebral aneursym clipping had changed in response to the IHAST II trial results.
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PMID:IHAST II and the response of neuroanaesthetists. 1826 31

Induced hypothermia is one of the most promising neuroprotective therapies. Technological limitations and homeostatic mechanisms that maintain core body temperature have impeded the clinical use of hypothermia. Recent advances in intravascular cooling catheters and successful trials of hypothermia for cardiac arrest and neonatal asphyxia renewed interest in hypothermia for stroke, resulting in early phase clinical trials and plans for further development. This review elaborates on the clinical implications of hypothermia research in stroke and technical and logistical issues associated with the application of hypothermia.
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PMID:Induced hypothermia for acute stroke. 1787 86

In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and discusses associated risks and complications.
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PMID:Thermoregulatory management for mild therapeutic hypothermia. 1913 13


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