Hipotermia terapéutica en la asistencia al neonato con encefalopatía hipóxico isquémica

  1. Dolores Macarro Ruiz
  2. Sánchez Sánchez, Judith
  3. Toledano Luna, Manuela
  4. Martínez Martín, Eduardo
  5. Martínez Galán, Paloma
  6. García Rebollo, Miguel Ángel
Revista:
Metas de enfermería

ISSN: 1138-7262

Ano de publicación: 2015

Volume: 18

Número: 7

Tipo: Artigo

Outras publicacións en: Metas de enfermería

Resumo

Objective: to analyze the scientific evidence available about the circumstances previous to labour which precede neonatal asphyxia in time, and about the protocol for whole-body moderate hypothermia in order to prevent or reduce the brain damage associated with perinatal hypoxic-ischemic aggression. Method: an integrative review where a literature search was conducted in the following databases: Medline, Cinahl, Cochrane Plus, Cuiden, Cuidatge, Bireme and Enfispo. The search was limited to the Spanish and English languages, and there was no limitation in years. As inclusion criteria, the following were selected: systematic reviews, meta-analyses, non-systematic reviews, and clinical trials on the subject, including original studies published up to this date. Results: perinatal hypoxic-ischemic encephalopathy is one of the most dramatic and unexpected events that can affect a newborn (NB) and his/her family. Different studies have demonstrated that at 18 months of age, therapy with hypothermia has reduced significantly the number of deaths and major disabilities vs. traditional therapy, as well as the benefits offered by whole-body cooling and by selective brain cooling. Conclusions: the evidence available supports the use of therapeutic hypothermia in managing newborns with hypoxic-ischemic encephalopathy.

Referencias bibliográficas

  • García Alix A, Martínez Biarge M, Arnaez J, Valverde E, Quero J. Asfixia intraparto y encefalopatía hipóxico isquémica. Madrid: Asociación Española de Pediatría; 2008 [citado 8 mar 2015]. Disponible en: http://www.aeped.es/sites/default/files/documentos/26.pdf
  • Morales Sabogal AY. Asfixia perinatal. En: Ucrós Rodríguez S, Mejía Gaviria N. Guías de Pediatría Basada en la Evidencia. 2ª ed. Bogotá: Editorial Médica Internacional Ltda; 2009.
  • Delgado Rubio A. Protocolos diagnósticos y terapéuticos de neonatología en pediatría. Madrid: Asociación Española de Pediatría; 2002.
  • Pietrini D, Piastra M, Luca E, Mancino A, Conti G, Cavaliere F. Neuroprotection and hypothermia in infant and children. Curr Druc Target 2012; 13:925-35.
  • Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP. Part 11: Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations. Circulation 2010; 122:S516-523.
  • García Alix A, Martínez Biarge M, Díez J, Gayá F, Quero J. Incidencia y prevalencia de la encefalopatía hipóxico isquémica en la primera década del s. XXI. An Pediatr 2009; 71:319-26.
  • Blanco D, García Alix A, Valverde E, Tenorio V, Vento M, Cabañas F. Neuroprotección con hipertermia en el recién nacido con encefalopatía hipóxico isquémica. Guía de estándares para su aplicación. Comisión de estándares para su aplicación clínica. An Pediatr 2011; 75(5):341.e1-341.e20.
  • Thoresen M, Satas S, Løberg E, Whitelaw A, Acolet D, Lindgren C, et al. Twenty-four hours of mild hypothermia in unsedated newborn pigs starting after a severe global hypoxic-ischemic insult is not neurprotective. Pediatr Res 2001; 50:405-11.
  • Morray JP, Pavlin EG. Oxygen delivery and consumption Turing hypothermia and rewarming in the dog. Anesthesiology 1990; 72:510-6.
  • Van der Linden J, Ekroth R, Lincoln C, Pugsley W, Scallan M, Tydén H. Is cerebral blood flow/metabolic mismatch during rewarming a risk factor after profound hypothermic procedures in small children? Eur J Cardiothorac Surg 1989; 3(3):209-15.
  • Blanco D. Presente y futuro de la neuroprotección con hipotermia. An Pediatr 2011; 75(5):295-7.
  • García Alix A, Martínez Biarge M, Díez J, Gayá F, Quero J. Incidencia y prevalencia de la encefalopatía hipóxico isquémica en la primera década del siglo XXI. An Pediatr 2009; 71:319-26.
  • Gluckman PD, 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.
  • 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 Oct 13; 353(15):1574-84.
  • Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Edmund Juszczak E, et al. Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy N Engl J Med 2009; 361:1349-1358.
  • Simbruner G, Mittal RA, Rohlmann F, Muche R and neo.nEURO.network Trial Participants. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126(4):e771-8.
  • Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, Wright IM. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165(8):692-700.
  • Jacobs SE, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2007; (4):CD003311.
  • Edwards AD, Brocklehurst P, Gunn AJ, Halliday H, Juszczak E, Levene M, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ 2010; 340:c363.
  • Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012; 166(6):558-66.
  • Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr 2010; 157(3):367-72.
  • Gunn AJ, Gluckman PD, Gunn TR. Selective head cooling in newborn infants after perinatal asphyxia: a safety study. Pediatrics 1998; 102(4 Pt 1):885-92.
  • Gunn AJ, Gunn TR, Gunning MI, Williams CE, Gluckman PD. Neuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep. Pediatrics 1998; 102(5):1098-106.
  • Li T, Xu F, Cheng X, Guo X, Ji L, Zhang Z, et al. Systemic hypothermia induced within 10 hours after birth improved neurological outcome in newborns with hypoxic-ischemic encephalopathy. Hosp Pract (Minneap.) 2009; 37(1):147-52.
  • García Alix A. Hipotermia cerebral moderada en la encefalopatía hipóxico isquémica. Un nuevo reto asistencial en neonatología. An Pediatr 2009; 71(4):281-3.
  • ClinicalTrials.gov [Internet]. Late Hypothermia for Hypoxic-Ischemic Encephalopathy. [citado 8 Mar 2015]. Disponible en: https://clinicaltrials.gov/ct2/show/NCT00614744