• Annals of neurology · Apr 2013

    Randomized Controlled Trial

    Elevated temperature and 6- to 7-year outcome of neonatal encephalopathy.

    • Abbot R Laptook, Scott A McDonald, Seetha Shankaran, Bonnie E Stephens, Betty R Vohr, Ronnie Guillet, Rosemary D Higgins, Abhik Das, and Extended Hypothermia Follow‐up Subcommittee of the National Institute of Child Health and Human Development Neonatal Research Network.
    • Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, RI.
    • Ann. Neurol. 2013 Apr 1;73(4):520-8.

    ObjectiveA study was undertaken to determine whether higher temperature after hypoxia-ischemia is associated with death or intelligence quotient (IQ)<70 at 6 to 7 years among infants treated with intensive care without hypothermia.MethodsControl infants (noncooled, n=106) of the National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial had serial esophageal and skin temperatures over 72 hours. Each infant's temperature was ranked to derive an average of the upper and lower quartile, and median of each site. Temperatures were used in logistic regressions to determine adjusted associations with death or IQ<70 at 6 to 7 years. Secondary outcomes were death, IQ<70, and moderate/severe cerebral palsy (CP). IQ and motor function were assessed with Wechsler Scales for Children and Gross Motor Function Classification System. Results are odds ratio (OR; per degree Celsius increment within the quartile or median) and 95% confidence interval (CI).ResultsPrimary outcome was available for 89 infants. At 6 to 7 years, death or IQ<70 occurred in 54 infants (37 deaths, 17 survivors with IQ<70) and moderate/severe CP in 15 infants. Death or IQ<70 was associated with the upper quartile average of esophageal (OR=7.3, 95% CI=2.0-26.3) and skin temperature (OR=3.5, 95% CI=1.2-10.4). CP was associated with the upper quartile average of esophageal (OR=12.5, 95% CI=1.02-155) and skin temperature (OR=10.3, 95% CI=1.3-80.2).InterpretationAmong noncooled infants of a randomized trial, elevated temperatures during the first postnatal days are associated with increased odds of a worse outcome at 6 to 7 years.Copyright © 2012 American Neurological Association.

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