Therapeutic Hypothermia for Perinatal Asphyxia

Lee, Byong Sop

Abstract

Several well-designed multicenter clinical trials of therapeutic hypothermia, maintaining rectal temperature of 33-34degrees C for 72 hours in neonates suffered from perinatal asphyxia, have demonstrated both safety and efficacy of therapeutic hypothermia in improving survival and neurodevelopmental outcomes. However, issues regarding the optimal cooling method, the target temperature and the duration of the hypothermia remain unsettled. To overcome limited efficacy of therapeutic hypothermia in the subgroup of infants with severe hypoxic ischemic encephalopathy, a few promising hypothermia-combined therapies, targeting the several steps in the pathogenesis of hypoxic ischemic encephalopathy, are now under investigation. Further data on the neurodevelopmental outcome of the study population of the finished or ongoing clinical trials, during the childhood period or thereafter, are required to settle therapeutic hypothermia as "a standard of care" against perinatal asphyxia. Nationwide establishment of efficient patient referral system and intimate communication of cooling protocol between obstetricians and neonatologists will make therapeutic hypothermia in neonates more available in Korea.