Wayock et al studied neonates with hypoxic-ischemic encephalopathy who underwent whole-body hypothermia. They identified risk factors for severe brain injury. The authors are from the Johns Hopkins University.
Patient selection: neonate at >= 35 weeks gestation with hypoxic-ischemic encephalopathy treated with whole-body hypothermia (rectal temperature 33/5°C for 72 hours)
Outcome: severe brain injury (abnormal brain MRI at 7-10 days) or death
Risk factors for severe brain injury on multivariate analysis:
(1) low initial neonatal arterial pH (pH < 7.0)
(2) longer time to spontaneous respirations (> 30 minutes)
(3) lack of exposure to oxytocin during intrapartum period
where:
• Lack of exposure to oxytocin would be seen with emergency C-sections.
• Low initial neonatal arterial pH was associated with an increased base deficit and more severe metabolic acidosis.
The risk factors can be determined within 30 minutes of delivery. A neonate at risk may benefit from more intensive neuroprotective therapy.
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