(Stroke. 1999;30:1153.)
© 1999 American Heart Association, Inc.
Letters to the Editor |
Body Temperature and Outcome of Asphyxiated Neonate
Division of Neonatology, Department of Child Health, Sultan Qaboos University Hospital, Al-Khoud, Sultanate of Oman
Key Words: • temperature • newborn • asphyxia
To the Editor:
In reference to the articles by Castillo et al1 and Schwab et al2 about the role of body temperature on asphyxiated brain, I would like to share the findings of our study on asphyxiated neonates, which had contradictory results. We reviewed 8 asphyxiated neonates (1-minute Apgar score of <5) with respect to their temperature at birth and their outcome. The data were collected with respect to birth weight, sex, Apgar score, and acid base status (blood pH and base excess) at birth. The temperature was noted from the nursing sheet. Outcome variables were the mortality and duration of stay (in days) in the hospital. The mean birth weight of the cohort was noted to be 3149±439 grams, with a male-to-female ratio of 1:1. The hypothermic asphyxiated neonates (birth temperature between 32°C and 36°C) were noted to have increased mortality (25%) compared with the 0% mortality in normothermic asphyxiated neonates (birth temperature of >36°C). The mean duration of stay for hypothermic asphyxiated neonates was 12 days, compared with 4 days for normothermic asphyxiated neonates. Statistical tests were not applied in view of the small sample size. Our findings of increased mortality and prolonged stay in the hospital in hypothermic asphyxiated neonates is contradictory to those in previous reports.3 4 5 Increased mortality in hypothermic neonates can be explained by the decreased metabolic activity and energy failure (decreased generation of ATPs) secondary to hypothermia. Another possibility is the decreased cardiac contractility associated with hypothermia, as shown in one animal model study,6 leading to decreased perfusion of the organs and causing multiorgan failure. Also, previous studies have shown increased incidence of complications in neonates with hypothermia.7 8 In this era of evidence-based medicine, more work will be needed before hypothermia can be implied as a therapeutic measure in the management of brain asphyxia.
References
1.
Castillo J, Davalos A, Marrugat J, Noya M. Timing
for fever-related brain damage in acute ischemic stroke.
Stroke. 1998;29:2455–2460.
2.
Schwab S, Schwarz S, Spranger M, Keller E, Bertram M,
Hacke W. Moderate hypothermia in the treatment of patients with severe
middle artery infarction. Stroke. 1998;29:2461–2466.
3. Dunn JM, Miller JA. Hypothermia combined with positive pressure ventilation in resuscitation of asphyxiated newborn. Am J Obstet Gynecol. 1969;104:58–67.[Medline] [Order article via Infotrieve]
4. Westin B, Nyberg R, Miller JA, Wedenberg E. Hypothermia and transfusion with oxygenated blood in treatment of asphyxia neonatorum. Acta Pediatr Scand Suppl. 1962;139:1–80.
5. Thoresen M, Wyatt JS. Keeping a cool head, post-hypoxic hypothermia: an old idea revisited. Acta Paediatr. 1997;86:1029–1033.[Medline] [Order article via Infotrieve]
6. Steen PA, Milde JH, Michenfelder TD. The detrimental effects of prolonged hypothermia and rewarming in the dog. Anesthesiology. 1980;52:224–230.[Medline] [Order article via Infotrieve]
7. Michenfelder JD, Milde JH. Failure of prolonged hypocarbia, hypothermia, or hypertension to favorably alter acute stroke in primates. Stroke. 1997;28:87–91.
8. Mann TP, Elliott RIK. Neonatal cold injury due to accidental exposure to cold. Lancet. 1957;1:229–234.
Response
Servicio de Neuroloxía, Hospital Xeral de Galicia, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
We appreciate Dr Manzar's interest in our study.1 However, medicine based on evidence is supported by clinical experiences in homogeneous populations suffering from the same disease. Therefore, the results obtained in asphyxiated newborns must not be used to recommend therapeutic modifications in adults with acute ischemic stroke.
References
1. Castillo J, Dávalos A, Marrugat J, Noya M. Timing for fever-related brain damage in acute ischemic stroke. Stroke. 1998;29:2455–2460.
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