Abstract Ref Number = APCP1063
SHORT TERM OUTCOME OF COOLING THERAPY IN INFANT WITH MODERATE HYPOXIC ISCHEMIC ENCEPHALOPATHY
Adhie Nur Radityo,Albert You,Putri Maharani Tristanita Marsubrin
Abbott Nutrisi Cipto Mangunkusumo Hospital
Background : Hypoxic ischemic encephalopathy (HIE) is a major cause of mortality and long-term morbidity in affected infants. Hypothermia is a potential neuroprotective intervention to treat HIE. Randomized controlled trials have shown that mild therapeutic hypothermia (cooling) initiated within 6?hour of birth reduces death and disability in these infants. Meta-analysis trials suggest that for every six or seven infants with moderate to severe HIE treated with mild hypothermia, there will be one fewer infant who dies or has significant neurodevelopmental disability.
Case Presentation Summary : A baby girl (36 weeks GA, 2430 gram) was born through caesarean section with poor muscle tone, cyanotic, inadequate work of breathing, and HR <100 x/minute. After resuscitation and stabilization, the baby experienced seizure. Thompson score at the age of 1 hour was 7; therefore, passive and active cooling with blanketroll began at age 1.5 hour. Blood Gas Analysis (BGA) showed sign of neonatal asphyxia. Mean arterial Pressure (MAP) was high and fluctuated until age 47 hour. During evaluation at age 48 hour, Thompson score increased from 4 to 6, the Near Infrared Spectroscopy (NIRS)-monitored regional cerebral oxygen saturation (rScO2) increased from 66 to 73% and cerebral fractional tissue oxygen extraction (cFTOE) decreased from 0.34% to 0.27%. Head ultrasound showed grade 1 bilateral IVH (intraventricular hemorrhage).
Learning Points/Discussion : Hypothermia impacted the ability of key markers of severe encephalopathy (neurologic exam) to predict outcome. This report was limited to no aEEG monitoring. BGA, NIRS, MAP, and Thompson score were evaluated during cooling. The reference value of rScO2 in premature infant trended to increase during the first 36 hours of life and reach its peak at age 36-42 hour before going downward at age 48 hour. Higher rScO2 (and lower cFTOE) values suggested cerebral hyper perfusion. Following 72 hours of cooling, the baby expressed poor sucking, hyper secretion, and thrombocytopenia, suggesting poor outcome.
Keywords: cooling therapy hypoxic ischemic encephalopathy Thompson score Near Infrared Spectroscopy