Therapeutic hypothermia has currently become a standard of care for asphyctic newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE). Strict criteria are required to include these newborns in the hypothermic treatment. On some occasions, in the clinical practice, some discrepancies were found among the 3 inclusion criteria. In such circumstances the knowledge of the accuracy of each criterion, the knowledge of the evolution of clinical and neurophysiologic parameters in the few hours following birth, and the knowledge of the pathogenesis of the asphyxia can help to take the right decision on who to treat with hypothermia. The usefulness of hypothermia in newborns of gestational age lower than 36 weeks or when started beyond the 6th hour of life remains unclear. Perinatal stroke, as HIE, is an evolving process and if early diagnosed could benefit from hypothermia. In addition, infants may experience hypoxic-ischemic episodes that are not related to the birth such as early apparent life-threatening events (ALTEs) or near miss events. Also in these cases hypothermia can be theoretically efficacious in preventing the progression of brain damage.
The above issues will be discussed in the present paper.
Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research