Institutionen för klinisk vetenskap / Department of Clinical Sciences
Abstract
Hypothermia treatment (HT) is now proven to be neuroprotective, is
associated with favourable outcomes, and is considered as the standard of
care for moderate to severe hypoxic ischemic encephalopathy (HIE). The
treatment should be regionalized with a minimum of ten treated infants
per year with regard to securing patient safety, staff training,
development and future research. Still, many infants are in desperate
need of additional therapies for neuronal rescue to reduce the risk of
death or severe handicap. The implementation of a national HT register
has revealed differences in the regional incidence of HT, indicating that
infants that could benefit from HT do not receive this therapy.
All of the following main findings in this thesis have lead to changes in
clinical practice:
* Prevention of HIE by using fetal scalp blood lactate combined with
fetal heart rate/cardiotocogram during labour is feasible. We
consider fetal scalp blood lactate measurement at the cut-off level
at of 4.8 mmol/L (75th percentile) to be a better predictive marker
for hypoxia-ischemia during labour than pH. The predictive capacity
is higher and the sampling technique is easier, with a high success
rate.
* Early induction of HT is feasible prior to transport. Earlier start
of HT could mean that the neuroprotective effect is more beneficial.
However, passive cooling results in a high risk of excessive cooling
and should be used with caution, i.e. temperature should be monitored
continuously and personnel should be trained in HT induction at all
delivery units.
* Moderate HT alters the predictive value of amplitude integrated EEG
(aEEG) in asphyxiated infants. These findings are of central value in
the context of early prognosis and in decision making for withdrawal
or continuation of intensive care treatment.
* The overwhelming majority of infants with moderate neonatal
encephalopathy (NE) have major and/or cognitive disabilities at
long-term follow-up. Most children with cerebral paresis (CP) also
have cognitive dysfunctions. This is of great importance for early
therapeutic interventions, allocation of habilitation resources and
support for the educational system
In conclusion our findings gives an additional diagnostic tool in
prevention of HIE, gives important information on implementation of
hypothermia treatment and emphasis the necessity of long-term follow-up
in encephalopatic infants