Cooling in mild encephalopathy: Costs and perils of therapeutic creep.
Semin Fetal Neonatal Med
; 26(3): 101244, 2021 06.
Article
in En
| MEDLINE
| ID: mdl-33849797
ABSTRACT
Increasing confidence in therapeutic hypothermia and ambiguity of cooling guidelines has led to many clinicians extending its use to untested populations like mild encephalopathy, or even no encephalopathy. Poor quality clinical neurological examination for encephalopathy staging coupled with a fear of litigation if a baby with mild encephalopathy progress to moderate or severe encephalopathy appears to be the primary driver for this therapeutic creep. Recent data suggesting increased apoptosis with cooling uninjured brains, and lack of hypothermic neuroprotection in partial prolonged hypoxia, implies that such therapeutic creeps may cause more harm than benefit. Currently available preclinical and clinical data do not support the clinical use of therapeutic hypothermia for mild encephalopathy, although phase II clinical trials are ongoing. We recommend that until further evidence from adequately powered randomised controlled trials are available, cooling in mild encephalopathy need to be considered experimental and parental consent should be obtained before providing this therapy.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hypoxia-Ischemia, Brain
/
Hypothermia, Induced
Type of study:
Clinical_trials
/
Guideline
/
Health_economic_evaluation
Limits:
Humans
/
Infant
Language:
En
Journal:
Semin Fetal Neonatal Med
Journal subject:
PEDIATRIA
/
PERINATOLOGIA
Year:
2021
Document type:
Article
Affiliation country:
United kingdom