Orozco GA, Alcocer AC, Sauviñón TP, Gil RC, Calderón JC

Language: Spanish
References: 16
Page: 179-184
PDF size: 118.95 Kb.

ABSTRACT

Hypothermia is the only effective treatment to reduce mortality and sequelae in asphyxia. The patient should have a pH less than 7.15 with base deficit greater than 16 in the first hour of life, a sentinel event or perinatal asphyxia; required more than 10 minutes of ventilation at birth or Apgar score less than 5 at 5 minutes. Initially should stabilize the pH, CO₂, oxygen and glucose and start the cooling until 33-34 °C in the first 6 hours of life and maintain for 72 hours, monitor glucose levels, blood pressure, urine output, platelets, and bleeding. You can use equipment automatized or manual to cool the patient, and must monitor the rectal or esophageal temperature, once the baby has cooled should be maintained in the desired range using the cooler and radiant warmer. Due to the large number of cases occurring in Mexico, population dispersion and transport difficulties all Neonatal Intensive Care Units must create a cooling protocol.

REFERENCES

1. Jacobs SE, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database of Systematic Reviews. 2007, Issue 4. Art. No: CD003311. Doi: 10.1002/14651858.CD003311.pub2.

2. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF et al. Whole-body hypothermia for neonates with hypoxic–ischemic encephalopathy. N Engl J Med. 2005; 353: 1574-84. Doi: 10.1056/NEJMcps050929.

3. Gluckman DP, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005; 365(9460): 663-70.

4. Fanaroff and Martin’s. Neonatal-perinatal medicine diseases of the fetus and infant. Elsiever Mosby, Philadelphia, PA. 2006: 941.

5. Solimano A. Acute care of at risk newborns. ACoRN Neonatal Society. Vancouver, British Columbia, Canada. August 2012.

6. Salhab WA, Wyckoff MH, Laptook AR, Perlman JM. Initial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia. Pediatrics. 2004; 114: 361-6.

7. Jerez-Calero A. Hipotermia en recién nacidos asfícticos. Protocolo de manejo. Bol SPAO. 2011; 5(2): 50-62.

8. Gunn AJ. Cerebral hypothermia for prevention of brain injury following perinatal asphyxia. Curr Opin Pediatr. 2000; 12(2): 111-5.

9. Robertson NJ, Kendall GS, Thayyil S. Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy. Semin Fetal Neonatal Med. 2010; 15: 276-86.

10. Polderman K. Application of therapeutic hypothermia in the Intensive Care Unit: opportunities and pitfalls of a promising treatment modality. Part 2: Practical aspects and side effects. Intensive Care Med. 2004; 30: 757-69.

11. Heldmaier G, Ruf T. Body temperature and metabolic rate during natural hypothermia in endotherms. J Comp Physiol B. 1992; 162: 696-706.

12. Azzopardi D, Strohm B, Edwards A, Dyet L, Halliday HL, Juszczak E et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009; 361: 1349-58.

13. Shankaran SLA, Ehrenkranz RA et al. National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic ischemic encephalopathy. N Engl J Med. 2005; 353: 1574-84.

14. American Academy of Pediatrics; American Heart Association. Neonatal Resuscitation. 6th. Association Guidelines for Neonatal Resuscitation, 2011.

15. Sistema Nacional de Información en Salud. Secretaría de Salud México. Disponible en: http://www.sinais.salud.gob.mx/mortalidad/index.html

16. Murguia SMT, Lozano R, Santos JI. Mortalidad perinatal por asfixia en México: Problema prioritario de salud pública por resolver. Bol Med Hosp Infant Mex. 2005; 62: 375-83.