Investigating the Use of Therapeutic Hypothermia in Partially Eligible Infants: A Single-centre Experience

Aim: Neonatal encephalopathy remains one of the most significant causes of neonatal morbidity and mortality. The present study compared the risk factors, demographic data, laboratory and imaging findings, and short-term outcomes of two groups of patients. Materials and Methods: A retrospective analysis was conducted on 45 patients who had undergone therapeutic hypothermia (TH) between January 1st, 2021, and August 31st, 2023. According to blood gas parameters; Group 1 (32 patients) met the criteria (pH ≤7.0 and/or base excess BE ≤-16) for TH, while Group 2 (13 patients) did not (pH >7.0, BE >-16, and with an absence of clinical findings). Results: A comparison of the demographic data revealed higher incidences of birth trauma (p=0.046) and neonatal risk (p=0.026) in Group 1 than in Group 2, with no other significant differences. Severe amplitude electroencephalogram (aEEG) abnormalities were more common in Group 1 but one patient of Group 2 displayed moderate abnormality during follow-up. A comparison of all imaging findings [aEEG, transfontanelle ultrasonography (USG), abdominal USG, cranial magnetic resonance imaging, echocardiography] revealed no significant differences (p=0.45). At the end of the follow-up period, 35 patients (77.7%) were discharged, while two (4.4%) patients did not survive (both in Group 1). Upon discharge, all patients in Group 2 exhibited normal neurological examination findings. Conclusion: Re-evaluating the existing criteria for the identification of those infants who may benefit from TH, but who are often deemed ineligible due to incomplete adherence to the treatment criteria, could significantly reduce the mortality and morbidity associated with birth asphyxia.