A recent study funded by the National Institutes of Health (NIH) has found that cooling treatment, which is known to benefit near-term and term infants with hypoxic ischemic encephalopathy (HIE), does not improve outcomes for preterm infants born at 33 to 35 weeks of gestation. The study, published in JAMA Pediatrics, reveals that cooling therapy offers no significant advantages over standard care for preterm infants suffering from HIE, a form of brain damage caused by oxygen deprivation during birth.
Study Overview and Background HIE occurs when a lack of oxygen during labor and delivery disrupts normal brain development, leading to potential long-term neurological impairments. In earlier studies, cooling treatment has been shown to lower the risk of death or disability in near-term (born after 36 weeks) and term (born after 37 weeks) infants with HIE by cooling the body temperature to around 92 degrees Fahrenheit. This treatment was thought to be beneficial in preventing or minimizing brain damage caused by oxygen loss.
However, despite these promising findings in older infants, the current study shows that similar benefits are not observed for preterm infants born between 33 and 35 weeks of gestation. The research raises important questions about the applicability of cooling therapy for this more vulnerable population.
Study Methodology The study, led by Dr. Roger G. Faix from the University of Utah, involved 188 preterm infants with HIE who were born between 2015 and 2020. Of these, 88 infants were randomly assigned to receive cooling treatment, while 80 infants received standard care at normal body temperature. Researchers monitored the infants’ health and neurological outcomes from 18 to 22 months of age, evaluating key indicators such as death rates and the presence of moderate to severe disability.
Key Findings The results showed that 35% of the preterm infants who received cooling treatment either died or experienced significant disability, compared to 29% of those who were kept at normal temperature. More specifically, 20% of the cooling group died, compared to 12% in the standard care group. In terms of overall outcomes, preterm infants who underwent cooling therapy had a 74% higher risk of death or disability and an 87% higher risk of death compared to those who received standard care.
These findings suggest that cooling therapy, which has proven to be beneficial for older infants, may not be effective—and could even be harmful—for preterm infants with HIE.
Implications for Clinical Practice The findings of this study are crucial for clinical practices and guidelines related to the treatment of preterm infants with HIE. Despite growing use of cooling treatment in preterm populations, the lack of clear evidence supporting its benefits for this group raises concerns about its safety and effectiveness. Healthcare providers may need to reconsider the widespread application of cooling therapy for preterm infants and focus on alternative approaches that have been shown to improve outcomes for these vulnerable babies.
Dr. Faix and his colleagues caution that further research is needed to fully understand the potential risks and benefits of cooling therapy in preterm infants. Given the study’s results, it is clear that cooling treatment should not be recommended as a standard practice for preterm infants with HIE unless additional evidence supports its safety and efficacy for this group.
Conclusion The study highlights a significant shift in our understanding of cooling therapy for infants with HIE, especially for preterm babies. While the treatment has been successful for near-term and term infants, it appears to pose greater risks for preterm infants, who may not benefit from cooling in the same way. Researchers emphasize the need for further studies to explore alternative therapies and to refine treatment protocols for preterm infants suffering from oxygen deprivation during birth.
The study, supported by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), provides valuable insights that will guide future research and clinical care for infants with HIE.
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