• Alistair J Gunn, John S Wyatt, Andrew Whitelaw, John Barks, Denis Azzopardi, Roberta Ballard, A David Edwards, Donna M Ferriero, Peter D Gluckman, Richard A Polin, Charlene M Robertson, Marianne Thoresen, and CoolCap Study Group.
• Department of Physiology, University of Auckland, Auckland, New Zealand. aj.gunn@auckland.ac.nz
• J. Pediatr. 2008 Jan 1;152(1):55-8, 58.e1.

ObjectiveTo evaluate whether therapeutic hypothermia alters the prognostic value of clinical grading of neonatal encephalopathy.Study DesignThis study was a secondary analysis of a multicenter study of 234 term infants with neonatal encephalopathy randomized to head cooling for 72 hours starting within 6 hours of birth, with rectal temperature maintained at 34.5 degrees C +/- 0.5 degrees C, followed by re-warming for 4 hours, or standard care at 37.0 degrees C +/- 0.5 degrees C. Severity of encephalopathy was measured pre-randomization and on day 4, after re-warming, in 177 infants; 31 infants died before day 4, and data were missing for 10 infants. The primary outcome was death or severe disability at 18 months of age.ResultsMilder pre-randomization encephalopathy, greater improvement in encephalopathy from randomization to day 4, and cooling were associated with favorable outcome in multivariate binary logistic regression. Hypothermia did not affect severity of encephalopathy at day 4, however, in infants with moderate encephalopathy at day 4, those treated with hypothermia had a significantly higher rate of favorable outcome (31/45 infants, 69%, P = .006) compared with standard care (12/33, 36%).ConclusionInfants with moderate encephalopathy on day 4 may have a more favorable prognosis after hypothermia treatment than expected after standard care.

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