What has changed over 10 years in neonatal therapeutic hypothermia? Part 2: Practical advice based on literature review and the authors’ own experiences

Abstract

Mild therapeutic hypothermia, understood as controlled cooling of the body or its part (the head) below the physiological temperature, i.e. 36°C, in accordance with appropriate therapeutic protocols, was approved in 2006 by the US Food and Drug Administration as an experimental method in preventing long-term complications of hypoxia in term and near-term newborns, i.e. those born at ≥35+0 weeks of gestational age. In newborns, unlike in adults, the aim of this method is neuroprotection of the central nervous system. Reports indicating the beneficial effect of cold in reviving a “weak” newborn have been known for a long time. However, both the positive effects of controlled cooling in reducing the percentage of severe neurological complications associated with deep perinatal hypoxia and its safety were not properly confirmed until the turn of the 20th and 21st centuries, with extensive experimental data from animal studies and a number of clinical protocols (TOBY, ICE, NICHD, Cool-Cap). Hypothermia was officially included in the canon of therapeutic methods in neonatology by the American Academy of Pediatrics in 2009, and in 2013, it became a hospital service guaranteed and financed by the National Health Fund in Poland. In 2015, mild therapeutic hypothermia became the worldwide recommended treatment method for infants born with severe asphyxia, at risk of developing symptoms of hypoxic-ischaemic encephalopathy to at least a moderate degree according to the Sarnat grading scale. In this paper, the authors share their own experiences related to the use of therapeutic hypothermia in patients under 18 years of age and indicate the most important aspects of its evolution over the last decade based on data from the literature.