Abstract: Objective: To study feasibility of a simplified method of head
cooling using ice water filled rubber gloves in full term infants with moderate
to severe hypoxic-ischemic encephalopathy and whether very early induced
hypothermia would decrease mortality and incidence of convulsions in this group
of infants. Study Design: In this single center prospective cohort study,
full term inborn infants were assigned to intervention cohort or control cohort
based on the 24 hours on call staff physician preference. Patient selection was
based on perinatal evidence of hypoxic-ischemic insult and clinical
neurological findings on admission suggestive of moderate to severe
hypoxic-ischemic encephalopathy. Hypothermia was passively initiated at
delivery and was actively induced on admission. A simplified approach to
induced head cooling was used by applying ice water filled rubber gloves.
Combined selective head cooling and mild systemic hypothermia approach was
applied. Cooling was continued for 72 hours. Short term outcomes of infants in
the two cohorts were compared. Results: 106 infants were enrolled,
54 infants in intervention cohort and 52 infants in control cohort. Active
cooling was initiated in the intervention cohort at a median postnatal age of
57 minutes. The method of cooling was easy to learn and adopt by our unit
members. The mortality rate was not significantly different between the two
cohorts; 8/54 intervention cohort vs. 11/52 in the control cohort, p value
0.45. Infants in the intervention cohort had statistically significant
reduction in the incidence of clinical convulsions, 14/54 vs. 25/52, p value
0.026. Fewer infants in the intervention group had abnormal
electroencephalogram; 12/46 (26%) vs. 18/43 (42%) in the control group,
however this did not reach statistical significance. Conclusion: This
simplified method of head cooling is feasible and might be helpful to treat
newborn infants with hypoxic-ischemic encephalopathy in centers where
sophisticated equipments are not available.
