%0 Journal Article
%T Heart Rate and Arterial Pressure Changes during Whole-Body Deep Hypothermia
%A Giacomo Cavallaro
%A Luca Filippi
%A Genny Raffaeli
%A Gloria Cristofori
%A Federico Schena
%A Elisa Agazzani
%A Ilaria Amodeo
%A Alice Griggio
%A Simona Boccacci
%A Patrizio Fiorini
%A Fabio Mosca
%J ISRN Pediatrics
%D 2013
%R 10.1155/2013/140213
%X Whole-body deep hypothermia (DH) could be a new therapeutic strategy for asphyxiated newborn. This retrospective study describes how DH modified the heart rate and arterial blood pressure if compared to mild hypothermia (MH). Fourteen in DH and 17 in MH were cooled within the first six hours of life and for the following 72 hours. Hypothermia criteria were gestational age weeks; birth weight £¿g; clinical signs of moderate/severe hypoxic-ischemic encephalopathy. Rewarming was obtained in the following 6¨C12 hours (0.5¡ãC/h) after cooling. Heart rates were the same between the two groups; there was statistically significant difference at the beginning of hypothermia and during rewarming. Three babies in the DH group and 2 in the MH group showed HR < 80£¿bpm and QTc > 520£¿ms. Infant submitted to deep hypothermia had not bradycardia or Qtc elongation before cooling and after rewarming. Blood pressure was significantly lower in DH compared to MH during the cooling, and peculiar was the hypotension during rewarming in DH group. Conclusion. The deeper hypothermia is a safe and feasible, only if it is performed by a well-trained team. DH should only be associated with a clinical trial and prospective randomized trials to validate its use. 1. Introduction Hypoxic-ischemic encephalopathy (HIE) is a disease that induces death and severe neurological damage in newborns [1]. Hypothermia is now the first effective neuroprotective intervention for newborns that are critically ill following an asphyxial insult. Hypothermia showed a decrease in death or disability at 18 months [2¨C5]. Parkins et al. firstly introduced hypothermia as a neuroprotective method, but the side effects were higher, so the practice had been abandoned [6]. Meta-analysis about eight largest RCTs had confirmed that cooling reduced mortality without increasing handicap in survivors [7]. Two meta-analyses have confirmed that hypothermia was associated with a lower risk of death or moderate/severe neurodevelopmental disorder in childhood, but with an increased risk of arrhythmia and thrombocytopenia [8, 9]. Perlman suggested that deeper or more prolonged cooling could be able to treat more severe neonatal asphyxia [2]. The early studies of deep hypothermia (20¨C27¡ãC) have found some neurological benefits, but the side effects dramatically increased below 32¡ãC and passed all potential clinical benefits [10]. Shivering and cardiac arrhythmias were the most pronounced of these side effects [11, 12]. Cardiac arrhythmias, hypotension, hemoconcentration, sinus bradycardia, and peripheral vasoconstriction are
%U http://www.hindawi.com/journals/isrn.pediatrics/2013/140213/