Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Therapy:Solving Questions about Monitoring and Prognosis

Introduction: The hypoxic-ischemic encephalopathy is a significant cause of neurologic morbidity and mortality in the newborn. One of the standards of management is the hypothermia therapy that allows a reduction in the brain injury extension, making important to define the settings involving the admission to such therapy. The hypothermia therapy protocol demands an strict compliance of the inclusion criteria, one of them, the APGAR score at a determinate moment, no protocol includes its score at different times, the APGAR score helps the clinician to decide the therapeutic approach of this patients, and the tenth minute score has received priority over the other minute’s score, nevertheless many patients will lose the opportunity to be admitted for hypothermia therapy when this score is taken, although the ACOG has determined that it is the minute 5 APGAR that has the value to define neonatal asphyxia, most European and American protocols take the 10 minute APGAR score; besides it is possible that the newborn in the first 6 hours does not demonstrate the secondary damage, or energy failure that are generated up to 48 hours later, in which the use of hypothermia therapy has truly a therapeutic effect. Then it is imperative to analyze the early outcomes according to the APGAR in the minute 5 and 10 in patients admitted for hypothermia therapy. Methods: A descriptive study, and retrospective analysis of a cohort of 62 patients born in term with hypoxic ischemic encephalopathy, admitted at the intensive care unit of Clinica Universitaria Bolivariana, Medellin, Colombia, between 2014-2016. Results: The cohort of newborns exhibits a mortality of 8.1%, which was significantly associated with the presence of complications during hypothermia. The most frequent pattern found in the electroencephalographic line during the first day was suppression burst 45.2%, and heading to the end of the protocol, 51.6% achieved normalization; imaging findings such as the subcortical ischemia was the mostly found in 25.8%, but the hemorrhagic ones were only found in 12.9%. During a bivariate analysis a correlation between different outcomes were found, the most important of them, was the one among the presence of status during the electroencephalographic monitoring with an APGAR score under 5 at the fifth minute. Conclusions: It is important to take on consideration the five-minute APGAR score because of its relation with epileptic status development, which in our cohort was more frequent without clinical manifestation than with it during monitoring. This is important because of the negative prognosis that this implies in the short term, in addition the patients that presented epileptic status post medication had correlation with persistent abnormalities at the discharge, that is why the five-minute APGAR score under five can predict the neurological examination at the discharge and the epileptic status development as a predictive marker. This also creates a suspect that the recommendation to use hypothermia therapy without electroencephalographic monitoring is a dangerous practice, and makes it difficult to assess the response to it.