Evidence-Based Guidelines for the Effectiveness of Therapeutic Hypothermia and aEEG Monitoring for Hypoxic Ischemic Encephalopathy in Infants 35-42 Weeks Gestation
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Anoxic brain injury, or birth asphyxia, can lead to multiple reactions causing a change in brain function in neonates, known as hypoxic ischemic encephalopathy (HIE). An infant may return to normal, but brain injury can result in neuromotor or developmental delay, cerebral palsy, neurodevelopmental disability, or even death. Lowering core body temperature from 37 degrees Celsius to 33-35 degrees Celsius can lower the severity of damage. Therapeutic hypothermia (TH) lowers body temperature by the use of head, or whole body cooling. Hypothermia treatment is started when the neonate is less than six hours old, the temperature is maintained for 48-72 hours, with gradual rewarming to 37 degrees at a rate of 0.5 degrees per hour. Amplitude-integrated electroencephalography (aEEG) monitoring is often utilized at the bedside to determine the need for treatment, patient status during TH, as well as helping to predict long-term outcomes. Multiple randomized controlled trials (RCTs) implementing TH to treat moderate to severe have been performed in the past 15-20 years, demonstrating a continued decrease in mortality and long-term morbidity as evidenced by improved neurologic outcomes, physical and psychosocial health, and IQ scores.