Effectiveness and Outcome of Implementation Therapeutic Hypothermia Asphyxiated Neonates at Governmental Hospital in West Bank
An-Najah National University
Background: Birth asphyxia is the medical condition resulting from deficient supply of oxygen to the infant for extended period of time during the birth process, as a result for many etiology infant usually become cyanosis, bradycardia, Apgar score is low in the first 5 min. Extreme degrees of asphyxia are associated with high morbidity and mortality rates worldwide. There is an urgent need to improve outcomes in affected infants .Therapeutic hypothermia (TH) as whole body or selective head cooling has become a standard therapy for moderate-severe HIE in many developed countries to reduce neurological damage within the first 6 hrs of life, by systemic cooling to 34.5 ± 0.5°C for head cooling, for surface cooling (33.5 ± 0.5°C) and continuing for 72 hrs. Aims of the Study: To assess the effectiveness and outcome of implementation therapeutic hypothermia and the relationship between therapeutic hypothermia and mortality rate, seizure and to assess relationship between therapeutic hypothermia and staying day in MV & relationship between therapeutic hypothermia and neurodevelopment defect, primitive reflexes. Method: The study adopted the Quazi experimental design. The study included prospective study. Experimental group baby who received therapeutic hypothermia and historical study as control group who not received therapeutic hypothermia .Survey will be carried out at Neonatal Intensive Care Unit in Governmental Hospital in Jenin. The period is one year from February 2020 to September 2020. Results: There are no significant differences at 0.05 level between Experimental group and Control group in Age of mothers, and gestational age significant differences at 0.05 level between the Control group and the Experimental group in Continued need for PPV or Intubation at 10 mints (the P-value is less than 0.05), the percentage of infants needed PPV in the experimental group was 10(30.3%) which is significantly higher than that in the control group 0(0%), while the percentage of infants needed intubation in the experimental group was 23(69.7%) which is significantly lower than that in the control group 27(100%). First day IN control group mild HIE 2(7.4%) moderate 13(48.1%),sever 12(44.5%) , in experimental group 0(0%),30(90.9%),3(9.1%) respectively but in third day of treatment in control group mild, moderate, sever 0(0.0%),3(27.3%),24(72.7%)in experimental group 24(72.7%),9(27.3).0(0.0) respectively. The percentage of mortality for infants HIE in the control group 4(14.8%) was significantly higher than that in the experimental group 1(3%), while the percentage late neonatal death 0(0%) in the experimental group was significantly lower than that in the control group 7(25.9%) with P value 0.002.Regarding Seizures at the second and third day, the percentages of Non Seizures are 27(81.8%) and 28(84.8%) which significantly higher than that in the control group 8(29.6%) and 7(25.9%), while the percentage of Present Seizures in the experimental group are 6(18.2%) and 5(15.2%) which significantly lower than that in the control group 17(63%). Regarding MV after 6 hr from admission, the percentage in the experimental group 17 (53.1%) was significantly higher than that in the control group 7(25.9%). In the second day, the percentage in the experimental group 7(21.9%) was significantly higher than that in the control group 3(11.1%). Regarding Suck at the second day, the percentage of Weak Suck in the experimental group 25(75.8%) was significantly higher than that in the control group 7(25.9%), while the percentage of Absent Suck in the experimental group 7(21.2%) was significantly lower than that in the control group 18(66.7%) so feeding process in experimental group started feeding too early than control group who started at and above day 7 of finished cooling , but other started at day 3 of finished cooling in 9.1% , 4 day 15.2% ,5 day 45.5%, 6 day 18.2%, 7+ day 12.1%.Also the follow up assessment results showed in vision test there is no any vision loss on all babies who underwent cooling therapy compared with one vision loss on control group, the same matter in hearing test one hearing loss on control group with no losing in experimental group. Conclusions: Hypothermia is most benefit when establish in the first ≤6 hours in term infant and late prematurity GA ≥36 weeks who in HIE to limit damage in the brain. Infants offered hypothermia should meet inclusion criteria. Eligibility criteria include a pH of ≤7.0 or a base deficit of ≥16 mmol/L in a sample of umbilical cord blood or blood obtained during the first hour after birth, history of an acute perinatal event, a 10-minute Apgar score of <5, or assisted ventilation initiated at birth and continued for at least 10 minutes. In addition, a neurologic examination demonstrating moderate to severe HIE is essential. Recommendation: Excluded for the following baby in TH: Baby (<36 weeks), Baby WT <1800, HIE baby admitted after 6hr, Lethal congenital and chromosomal anomalies. The current hypothermia protocol is starting treatment within golden hours in the first 6 hrs of life, by systemic cooling to 34.5 ± 0.5°C for head cooling, for ( surface cooling ) or whole-body cooling(33.5 ± 0.5°C) and continuing for 72 hrs, also more researches needed included HIE babies who pass the first six gold hour and do TH in also first 12 hours by using wide sample size and observed the developmental defect later on like, school age.