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

Hypoxic-ischemic encephalopathy causes significant morbidity and mortality in neonates. Preventing the secondary reperfusion injury that occurs following a hypoxic-ischemic event is paramount to ensuring the best possible neurologic outcome for the neonate. Induced hypothermia is currently being studied in various institutions as a means of neuroprotection for neonates at risk of severe brain injury following a hypoxic-ischemic event. This article highlights the pathophysiology of hypoxic-ischemic encephalopathy and the rationale behind the effectiveness of induced hypothermia. Nursing care and management of neonates being treated with induced hypothermia are discussed.
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PMID:Induced hypothermia for neonates with hypoxic-ischemic encephalopathy. 1748 37

Carnitine-acylcarnitine translocase (CACT) deficiency is a rare disorder that results in long-chain fatty acids being unavailable for mitochondrial beta-oxidation and ketogenesis. It can present in the neonatal period or infancy with a severe clinical form, typically with convulsions, hypothermia, encephalopathy, cardiomyopathy and liver dysfunction, or with a milder phenotype with episodes of hypoglycaemia and hyperammonaemia during intercurrent illness. Investigations show hypoketonaemia, intermittent dicarboxyluria and hypocarnitinaemia with grossly elevated acylcarnitines. Enzyme assay or DNA analysis confirms the diagnosis. The severe phenotype results in severe disability or death. The less severe phenotype can also cause significant disability secondary to hypoglycaemia and/or hyperammonaemia at presentation. We report the outcome of two siblings with CACT deficiency. The index patient presented at the age of 2 months during a respiratory illness with hypoglycaemia, hyperammonaemia and cardiorespiratory collapse. Acylcarnitine profiles showed decreased free carnitine but striking elevations of long-chain acylcarnitines. Urine organic acids showed dicarboxylic aciduria. Fatty acid oxidation studies showed reduced oleate and myristate oxidation. His acylcarnitine profile normalized after he was started on a medium-chain triglyceride (MCT) low-fat diet and carnitine supplementation. Low CACT activity on enzyme assay confirmed the diagnosis. He has resulting profound developmental delay and epilepsy. The sibling was prospectively treated with a low-fat MCT diet and carnitine supplementation. Acylcarnitine profile at birth also showed elevated long-chain acylcarnitines. Fatty acid oxidation studies confirmed the diagnosis. To date he has normal development and has not had any significant periods of hypoglycaemia or hyperammonaemia.
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PMID:Prospective treatment in carnitine-acylcarnitine translocase deficiency. 1750 64

Although hypoxic-ischemic encephalopathy (HIE) is relatively rare, it commonly results in devastating long-term mortality and death. Intervention against this condition has been limited and frustrating. As research in this area progresses, a tremendous growth of knowledge about mechanisms involved with HIE is now contributing to the development of neuroprotective strategies. Hypothermia as a therapeutic intervention for HIE appears to be promising, as evident from recent human trials that suggest selective head cooling or total body cooling decreases the incidence of disability and death. Many questions, however, still remain unanswered about the use of hypothermia. Long-term efficacy and safety of hypothermia needs to be established before it can be recommended "as standard of care" for the treatment of neonatal HIE.
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PMID:Hypothermia and the treatment of the term gestation infant with perinatal hypoxic-ischemic encephalopathy. 1764 28

This chapter will report to the frequency of neonatal hypoxic-ischemic encephalopathy. The pathophysiology and the childhood outcome of encephalopathy due to hypoxia-ischemia will be examined. The limitations of current therapy for this condition and new therapies will be evaluated. Hypothermia seems to offer the most promise as a therapy for neuroprotection in hypoxic-ischemic encephalopathy. The evidence-based trials of hypothermia will be reviewed along with recommendations regarding clinical applications for this therapy and need for long-term follow-up of children receiving this therapy.
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PMID:Hypothermia as a treatment for birth asphyxia. 1776 14

Sepsis is a major clinical challenge that is associated with encephalopathy and multi-organ dysfunction. Current therapeutic interventions are relatively ineffective and the development of novel treatments is hampered by the lack of a well-characterised animal model. Therefore, the behavioural, metabolic, physiological and histological changes resulting from 'through and through' caecal ligation and puncture (CLP) in the rat were investigated to determine its suitability as an animal model of human sepsis. CLP resulted in bacteraemia, characterised by the presence of multiple enteric species within 18-20 h. Locomotor activity was reduced within 4 h of CLP and this reduction increased with time. Pyrexia was evident 4-5 h after CLP and was followed by hypothermia beginning 17 h after intervention. CLP resulted in reduced white blood cell and platelet counts and an increased neutrophil: lymphocyte ratio within 18-20 h. It also resulted in decreased blood glucose, but not lactate levels. CLP caused histopathological changes in the cerebral cortex, liver, lungs and vascular system indicative of multi-organ dysfunction. Therefore, CLP in the rat mimics the cardinal clinical features of human sepsis and the subsequent development of multi-organ dysfunction. It appears to be the best available animal model currently available, in which to investigate the underlying pathophysiology of sepsis and identify therapeutic targets.
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PMID:Caecal ligation and puncture in the rat mimics the pathophysiological changes in human sepsis and causes multi-organ dysfunction. 1782 20

Drowning is always a serious event, with high morbidity and mortality. Definitions were recently revised and simplified according to Utstein-style. The circumstances and prognosis differ in different age groups. Consequences of drowning are hypoxemia, acidosis and hypothermia. The management of drowning victims should be directed to the correction of these 3 elements. An early basic life support and an efficient oxygenation are keys of good prognosis, this one being mainly related to hypoxic cerebral damages. The most frequent complications except anoxic encephalopathy are bacterial pneumonia and ARDS.
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PMID:[Drowning]. 1789 47

Hypothermia has been shown to be neuroprotective in some newborns with moderate-to-severe perinatal hypoxic-ischemic encephalopathy (HIE). In 2006, the American Academy of Pediatrics recommended that institutions that choose to use therapeutic hypothermia do so in the context of a rigorous protocol, with systematic collection of patient data including neurodevelopmental follow-up. In this report, we describe our experience with implementation of a 'Hypothermia for HIE' program in a single tertiary care Neonatal Intensive Care Unit (NICU). Important components of the program include detailed protocols, staff and outreach education, early initiation of cooling in both inborn and outborn patients, maintaining stable hypothermia during neonatal transport, and comprehensive neurologic evaluation including serial EEGs, brain MRI and neurodevelopmental follow-up. In the first 2 years of the program, we have used hypothermia therapy in 21 patients, 18 with perinatal and 3 with early postnatal events leading to HIE. Eleven of fifteen outborn patients were cooled prior to and during transport, resulting in initiation of therapy 3 h sooner than if therapy had been delayed until arrival at our center. While lowering the body temperature of encephalopathic newborns is not difficult, addressing the complex medical problems of this vulnerable group of patients requires an experienced multidisciplinary team in regional referral centers.
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PMID:Implementation of a 'Hypothermia for HIE' program: 2-year experience in a single NICU. 1805 65

The patient in this study was a 43-year-old woman who had become unconscious after contracting influenza virus type A infection. Brain CT showed severe brain swelling. Brain MRI also showed brain edema with no specific abnormality on T2-weighted images. We diagnosed her as having influenza type A virus-associated encephalopahty and treated her with Oseltamivir, methylprednisolone pulse therapy, and a high dose of intravenous immunoglobulins. In addition, we treated her with hypothermia and a high dose of intravenous ATIII because of the severe brain swelling and possibility of DIC. After the treatments, brain swelling had improved, and she regained consciousness without any sequelae. Adult influenza virus-associated encephalopathy is rare. We were able to successfully treat our patient with primary multidisciplinary treatments without causing sequelae.
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PMID:[Case of adult influenza type A virus-associated encephalopathy successfully treated with primary multidisciplinary treatments]. 1809 96

In 2005, three randomised controlled trials (RCTs) showed that treating infants with hypoxic-ischaemic encephalopathy (HIE) with hypothermia decreased the combined outcome of death or disability at 12-18 months, although treatment effects were modest. More recently, the US Food and Drug Administration (FDA) approved a device for selective head cooling. In addition, the protocol from another of the three trials, using equipment available in many hospitals, has been in the public domain for over a year. Why has this not led to a consensus that hypothermia is the standard of care for HIE? This is explored. Important questions for future research will focus on ways to improve on initial results with cooling, such as drug plus hypothermia combination therapy and refining duration and depth of cooling or duration of rewarming. Although the latter are important questions for future clinical trials, those who are convinced by the evidence to date should focus on safe implementation of cooling using protocols with established safety and efficacy and should consider ways to increase access to cooling for eligible babies.
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PMID:Current controversies in hypothermic neuroprotection. 1809 52

Hypoxic-ischemic (HI) brain injury is the most common cause of encephalopathy and seizures in term newborn infants. There is no single, valid test for birth asphyxia leading to HI brain injury, and thus this disorder is often poorly characterized, and the timing and etiology of the injury can be difficult to ascertain. Optimal management of HI brain injury involves prompt resuscitation, careful supportive care including prevention of hyperthermia and hypoglycemia, and treatment of clinical and frequent or prolonged subclinical seizures. Recent evidence suggests that therapeutic hypothermia by selective head or whole-body cooling administered within 6 hours of birth reduces the incidence of death or moderate/severe disability at 12 to 22 months. Hypothermia is a promising new therapy that physicians should consider within the context of a registry or study. Optimal seizure treatment remains controversial because the most widely used drug, phenobarbital, has limited efficacy, and the value of monitoring and treating subclinical seizures is uncertain. There is compelling need for well-designed clinical trials to address treatment of ongoing brain injury in the setting of hypoxia-ischemia and seizures. Emerging evidence from preclinical studies suggests that future therapy for HI brain injury and neonatal encephalopathy will combine novel neuroprotective and anti-seizure agents. Pilot clinical trials of newer anticonvulsants are ongoing and will provide critical information for care of neonatal seizures.
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PMID:Treatment of hypoxic-ischemic encephalopathy in newborns. 1817 41


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