NJ Robertson, D Azzopardi, AD Edwards

Abstract

There is now a large body of evidence from experimental studies that moderate brain hypothermia applied after hypoxia-ischaemia modifies the process of cell death and ameliorates cerebral injury. Pilot studies examining the feasibility and safety of moderate hypothermia in infants following perinatal hypoxia-ischaemia suggest that there are relatively few adverse systemic effects but that a cautious approach is required; an international randomized trial of head cooling is currently underway. The amplitude integrated EEG has been shown to be useful in selecting infants most likely to be benefit from treatment, however there is no consensus on whether selective head cooling or total body cooling is the preferred method of cooling. Experimental studies suggest that cooling needs to be started within six hours of the insult and continued for at least 72 hours for it to be effective. Until results of the multicentre trials are known there are insufficient data to advise the use of moderate hypothermia in clinical practice.