From the Guidelines
Therapeutic hypothermia should be initiated in infants with moderate or severe hypoxic-ischemic encephalopathy (HIE) to reduce the risk of death, neurodevelopmental impairment, and cerebral palsy, as evidenced by a recent study published in Circulation in 2024 1. Hypoxic-ischemic encephalopathy (HIE) is a significant cause of cerebral palsy (CP), with about 10-20% of infants with moderate to severe HIE developing cerebral palsy. The severity of cerebral palsy resulting from HIE depends on factors such as the duration and extent of oxygen deprivation, the areas of the brain affected, and how quickly treatment is initiated.
Key Findings
- The use of therapeutic hypothermia in infants with moderate or severe HIE has been shown to reduce the risk of death or neurodevelopmental impairment (NDI) at 18-24 months by 151 per 1000 infants, with a number needed to treat to benefit (NNTB) of 7 infants 1.
- Therapeutic hypothermia has also been shown to reduce the risk of cerebral palsy by 89 per 1000 infants, with a NNTB of 12 infants 1.
- The treatment must be started within 6 hours of birth and involves cooling the infant's body temperature to 33-34°C for 72 hours to reduce brain injury.
Management
- For established cerebral palsy resulting from HIE, management is multidisciplinary, including:
- Physical therapy
- Occupational therapy
- Speech therapy
- Medications for spasticity (such as baclofen, diazepam, or botulinum toxin injections)
- Sometimes surgical interventions
- Early intervention is crucial in both conditions to maximize developmental outcomes and minimize complications.
Prevention
- Preventing birth asphyxia and providing prompt treatment when HIE occurs are crucial to reducing the risk of developing cerebral palsy.
- The connection between HIE and cerebral palsy highlights the importance of prompt and effective treatment of HIE to improve outcomes for affected infants 1.
From the Research
Hypoxic Ischemic Encephalopathy and Cerebral Palsy
- Hypoxic-ischemic encephalopathy (HIE) is a serious condition that can lead to cerebral palsy and other long-term disabilities 2, 3.
- The pathophysiology of HIE is complex and involves impaired cerebral blood flow and oxygen delivery to the brain, resulting in primary and secondary energy failure 4, 5.
- Therapeutic hypothermia has emerged as a standard treatment for HIE, and has been shown to improve outcomes and reduce the risk of adverse outcomes, including cerebral palsy 6.
- Other experimental treatments, such as drug therapy and stem cell therapy, are being explored as adjunctive treatments to hypothermia therapy, and may hold promise for improving outcomes in infants with HIE 4, 5.
Risk of Cerebral Palsy
- Infants with HIE are at high risk of developing cerebral palsy, with studies suggesting that 40-60% of affected infants may die or have severe disabilities by 2 years of age 5.
- The implementation of therapeutic hypothermia programs has been shown to reduce the observed neurological morbidity of surviving HIE infants, including the risk of cerebral palsy 6.
- Early diagnosis and treatment of HIE are critical to improving outcomes and reducing the risk of long-term disabilities, including cerebral palsy 2, 3.
Current Treatment Options
- Therapeutic hypothermia is currently the standard treatment for HIE, and involves cooling the infant's body temperature to reduce brain injury and improve outcomes 2, 6.
- Other treatment options, such as supportive medical therapy, are also used to manage infants with HIE, but may not be as effective in improving outcomes 5.
- Experimental treatments, such as drug therapy and stem cell therapy, are being explored as adjunctive treatments to hypothermia therapy, and may hold promise for improving outcomes in infants with HIE 4, 5.