Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan
Authors: Tsuda Kennosuke , Mukai Takeo , Iwata Sachiko , Shibasaki Jun , Tokuhisa Takuya , Ioroi Tomoaki , Sano Hiroyuki , Yutaka Nanae , Takahashi Akihito , Takeuchi Akihito , Takenouchi Toshiki , Araki Yuko , Sobajima Hisanori , Tamura Masanori , Hosono Shigeharu , Nabetani Makoto , Iwata Osuke ,   The Baby Cooling Registry of Japan Collaboration Team, Adachi Hiroyuki , Aiba Satoru , Akiyoshi Shinnosuke , Amizuka Takasuke , Aoki Mikihiro , Arai Hirokazu , Arai Junichi , Asanuma Hideomi , Baba Atsushi , Bonno Motoki , Daimon Yusuke , Egashira Tomoko , Fukuhara Rie , Fukushima Naoki , Futamura Masahide , Harada Sayaka , Hattori Tsukasa , Henmi Nobuhide , Hiroma Takehiko , Hisano Tadashi , Ieda Kuniko , Iida Koichi , Iijima Shigeo , Imai Ken , Imamura Takashi , Inoue Shinkai , Ishiguro Akio , Suzuki Keiji , Ishii Tsutomu , Ito Takashi , Iwai Masanori , Iwataki Shinnichiro , Jinnai Wataru , Kai Akihiko , Kanbe Taro , Kinoshita Masahiro , Kanda Hiroshi , Kaneko Masatoshi , Kawase Akihiko , Kawato Hitoshi , Kida Yoshikazu , Kihara Minako , Kitano Hiroyuki , Kishigami Makoto , Shibata Naoaki , Kito Osamu , Kobayashi Akira , Kohno Yoshinori , Kokubo Minoru , Kondo Masatoshi , Konishi Eri , Kugo Masaki , Kouwaki Masanori , Kumagai Takeshi , Kusaka Takashi , Kusuda Takeshi , Maeda Tomoki , Maede Yoshinobu , Maji Tomoaki , Makiya Tomoko , Maruyama Kennichi , Masunaga Ken , Matsumoto Atsushi , Matsumoto Hiroshi , Matsumoto Naoko , Mima Aya , Minagawa Kyoko , Minosaki Yoshihiro , Minowa Hideki , Miura Mazumi , Miyata Masafumi , Miyazono Yayoi , Mizumoto Hiroshi , Mori Kazuhiro , Morioka Ichiro , Morisawa Takeshi , Nagaya Ken , Nagayama Yoshihisa , Naito Atsushi , Nakamura Kenji , Nakamura Makoto , Nakao Atsushi , Nakao Hideto , Nakazawa Yusuke , Nishimura Yutaka , Nishizaki Naoto , Nosaka Kazuhiko , Nozaki Masatoshi , Ochiai Masayuki , Ohashi Atsushi , Ohki Shigeru , Omori Isaku , Osone Yoshiteru , Saito Junko , Sato Yoshiaki , Sato Yoshitake , Seki Kazuo , Shirakawa Yoshitsugu , Shiro Hiroyuki , Suzumura Hiroshi , Takahashi Ritsuko , Takahata Yasushi , Taki Atsuko , Tanaka Taihei , Tateishi Itaru , Tsunei Mikio , Usuda Touhei , Yada Yukari , Yamamoto Junko , Yamamoto Masahito , Yoda Hitoshi , Yokoi Akiko , Yoshida Shinobu , Yoshida Taketoshi , Yoshida Tomohide , Yoshikawa Kayo 
Published: January 2017

Therapeutic hypothermia is recommended for moderate and severe neonatal encephalopathy, but is being applied to a wider range of neonates than originally envisaged. To examine the clinical use of therapeutic hypothermia, data collected during the first 3 years (2012–2014) of the Baby Cooling Registry of Japan were analysed. Of 485 cooled neonates, 96.5% were ≥36 weeks gestation and 99.4% weighed ≥1,800 g. Severe acidosis (pH < 7 or base deficit ≥16 mmol/L) was present in 68.9%, and 96.7% required resuscitation for >10 min. Stage II/III encephalopathy was evident in 88.3%; hypotonia, seizures and abnormal amplitude-integrated electroencephalogram were observed in the majority of the remainder. In-hospital mortality was 2.7%; 90.7% were discharged home. Apgar scores and severity of acidosis/encephalopathy did not change over time. The time to reach the target temperature was shorter in 2014 than in 2012. The proportion undergoing whole-body cooling rose from 45.4% to 81.6%, while selective head cooling fell over time. Mortality, duration of mechanical ventilation and requirement for tube feeding at discharge remained unchanged. Adherence to standard cooling protocols was high throughout, with a consistent trend towards cooling being achieved more promptly. The mortality rate of cooled neonates was considerably lower than that reported in previous studies.