Neurodevelopmental outcome of neonates with hypoxic ischemic encephalopathy who underwent therapeutic hypothermia

Abstract Background Hypoxic–ischemic encephalopathy secondary to acute perinatal asphyxia represents a major cause of long-term neurodevelopmental impairment in children. Therapeutic hypothermia is currently considered the standard of care for term neonates with moderate to severe hypoxic–ischemic encephalopathy. Objectives The present study was designed to evaluate the neurodevelopmental trajectory of neonates diagnosed with moderate to severe hypoxic–ischemic encephalopathy following therapeutic hypothermia. Methods This prospective observational cohort study included 41 neonates with a gestational age ≥ 36 weeks and a birth weight ≥ 1.8 kg who presented with moderate to severe hypoxic–ischemic encephalopathy. All infants underwent whole-body cooling, delivered either through active or passive methods, targeting a core temperature of 33.5 °C (range 33–34 °C). Surviving neonates were followed at three and six months of age to evaluate neurodevelopmental outcomes using the Bayley Scales of Infant Development. Results Early initiation of therapeutic hypothermia within the first 2 h was associated with decreased mortality ( p = 0.025). Lower Apgar score at 5 min and hypoxic changes in cranial ultrasound were associated with increased mortality ( p = 0.008) and ( p = 0.014). There was no difference between active and passive cooling regarding convulsions and complications, whereas the language Bayley score at 3 months and motor Bayley score at 6 months were significantly higher in the active cooling group ( p = 0.013, p = 0.022). Conclusion Earlier initiation of therapeutic hypothermia (first 2 h) improves survival rate, with no difference between active and passive cooling regarding seizures and complications.