Whole-body hypothermia in late preterm and early term infants: a retrospective analysis from a neurocritical care unit.
retrospective_cohort · Level III
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- Also identified by DOI 10.1038/s41390-025-04701-x.
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Abstract
To compare the outcomes of whole-body hypothermia (WBH) in infants with neonatal encephalopathy born at 34<sup>0/7</sup>-35<sup>6/7</sup> versus 36<sup>0/7</sup>-37<sup>6/7</sup> weeks' gestation. Retrospective analysis of 122 outborn infants in a single unit: Group 1 (n = 63; 34<sup>0/7-6/7</sup> weeks n = 17, 35<sup>0/7-6/7</sup> weeks n = 46) and Group 2 (n = 59; 36<sup>0/7-6/7</sup> weeks n = 25, 37<sup>0/7-6/7</sup> weeks n = 34). Clinical, electrographic, neuroimaging, neurodevelopmental data at 18 months were assessed. Group 1 had more hemodynamic instability (67% vs. 32%, p < 0.001), hypoglycemia (54% vs 36%, p = 0.04), and higher white-matter and total brain-injury scores (medians 7 vs. 4 and 10 vs. 5, both p ≤ 0.05), compared with Group 2. Overall mortality was 22% (14/63) vs. 12% (7/59), respectively (adjusted odds ratio [aOR] 3.49, 95% CI 1.06-11.50). Composite outcome of death or moderate-severe neurodevelopmental impairment (NDI) was more common in Group 1 (42% vs. 21%; aOR 2.94, 95% CI 1.02-8.46). The 35<sup>0/7-6/7</sup> vs. 36<sup>0/7-6/7</sup>-week subgroup comparison did not reach statistical significance for composite outcome (aOR 2.42, 95% CI 0.60-9.78, p = 0.2). However, among 35<sup>0/7-6/7</sup>-week infants, composite outcome was more common occurring in 45% compared with 21% at 36<sup>0/7</sup>-37<sup>6/7</sup> weeks (aOR 3.37, 95% CI 1.09-10.44, p = 0.03). At 34<sup>0/7</sup>-35<sup>6/7</sup> weeks, WBH was associated with greater physiological instability, more severe brain injury, and adverse outcomes. Late preterm infants born at 34<sup>0/7</sup>-35<sup>6/7</sup> weeks' gestation had higher rates of physiological instability, including hemodynamic instability and hypoglycemia during whole-body hypothermia compared to those born at 36<sup>0/7</sup>-37<sup>6/7</sup> weeks. Post-rewarming brain MRI showed higher white matter injury subscores and total brain injury scores in infants born at 34<sup>0/7</sup>-35<sup>6/7</sup> weeks' gestation compared to those born at 36<sup>0/7</sup>-37<sup>6/7</sup> weeks. After adjustment for encephalopathy severity, 34<sup>0/7</sup>-35<sup>6/7</sup> weeks' gestation late preterm infants had higher mortality and nearly twice the rate of composite adverse outcomes, highlighting their greater vulnerability to adverse outcomes following whole-body hypothermia compared with the more mature 36<sup>0/7</sup>-37<sup>6/7</sup> weeks group.