Rewarming the oxygen-deprived newborn may trigger epileptic seizures – Intensive care

Image: The warm-up period following the HIE cooling can cause seizures (Photo courtesy of Thermakid)

Newborns who undergo cooling therapy to protect them from hypoxic-ischemic encephalopathy (EHI) are at high risk of seizures and brain damage during the warming period, according to a new study.

Researchers from the University of Texas Southwestern Medical Center (UT Southwestern; Dallas, TX, United States), the United States National Institutes of Health (NIH; Bethesda, MD, United States) and other institutions conducted a study of 120 newborns (58% male) to determine whether electrographic seizures are more likely to occur during rewarming compared to the previous period, and whether they are associated with abnormal results in asphyxiated newborns receiving hypothermia treatment.

The primary endpoint was the occurrence of electrographic seizures during rewarming initiated at 72 or 120 hours, compared to the previous 12 hours. Serial electroencephalography (EEG) recordings were compared by two blind readers. Secondary outcomes included moderate or severe disability or death at 18-22 months of age. The results revealed that rewarming increased the risk of seizures by about three times. Plus, babies who had seizures while warming up were about twice as likely to die or have a neurological disability by age two. The study was published on October 18, 2021 in JAMA Neurology.

“Plenty of evidence has shown that cooling babies who do not get enough oxygen during birth can improve their neurodevelopmental outcomes, but few studies have examined the events that occur when they are warmed to a normal body temperature. “said Professor Lina, head of the study. Chalak, MD, of UT Southwestern. “This study tells us that there is an untapped opportunity to improve care for these babies during rewarming by making monitoring a standard part of the protocol.”

Millions of newborns around the world are affected by neonatal EHI, brain damage initially caused by a lack of oxygen during childbirth. To help improve results, hypothermia with the help of a cooling blanket that lowers body temperature up to 33.5 ° C is used. But studies have shown that during cooling, these babies usually have asymptomatic seizures, prompting monitoring of the EEG as part of the hypothermia protocol.

Related links:
University of Texas Southwestern Medical Center
United States National Institutes of Health

About Antoine L. Cassell

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