A Clínica PBSF nasce através do propósito de Proteger Cérebros e Salvar Futuros. Os responsáveis técnicos pela clínica sempre almejaram investir no cuidado integral dos pacientes pediátricos, investindo, portanto, desde o no cuidado especializado no pré-natal, dando suporte, se necessário, para aqueles que precisarem de cuidados avançados em UTIs e evoluindo para o seguimento desta criança, sendo ela com ou sem necessidades especiais (fig.01).
Por isso a Clínica PBSF já nasce com uma notoriedade e uma bagagem muito grande, com um time altamente especializado no conceito de atenção integral ao binômio mãe-filho, com uma capacidade técnica indiscutível, porém sem nunca se desconectar dos conceitos de humanização e acolhimento.
figura 01 – legenda da imagem
Objectives
To determine the effect of therapeutic hypothermia on death and long‐term neurodevelopmental disability, and to ascertain clinically important side effects in newborn infants with HIE.
Secondary objectives included assessment of the adverse effects of cooling and effects on early prognostic indicators of adverse outcome. Subgroup analyses were planned based on:
- severity of HIE a) based on Sarnat score (mild, moderate, severe) (Sarnat 1976; Finer 1981); b) based on electroencephalogram (EEG) or amplitude‐integrated electroencephalogram (aEEG) at baseline;
- inclusion criteria: electrophysiological plus clinical criteria versus clinical criteria alone;
- method of cooling (whole body versus selective head cooling with mild systemic hypothermia);
- duration of cooling (< 48 hours vs. ≥ 48 hours);
- quality of outcome assessment (high quality (> 18 months with formal psychological testing and review by developmental paediatrician for diagnosis of cerebral palsy (CP)) versus lower quality).
Methods
Criteria for considering studies for this review
Types of studies
We included all randomised and quasi‐randomised studies comparing the use of therapeutic hypothermia with standard care.
Types of participants
- Newborn infants of 35 weeks’ gestation or greater.
- Evidence of peripartum asphyxia, with each enrolled infant satisfying at least one of the following criteria:
- Apgar score of 5 or less at 10 minutes;
- mechanical ventilation or resuscitation at 10 minutes;
- cord pH < 7.1, or an arterial pH < 7.1 or base deficit of 12 or more within 60 minutes of birth.
- Evidence of encephalopathy according to Sarnat staging (Sarnat 1976; Finer 1981):
- Stage 1 (mild): hyperalertness, hyper‐reflexia, dilated pupils, tachycardia, absence of seizures;
- Stage 2 (moderate): lethargy, hyper‐reflexia, miosis, bradycardia, seizures, hypotonia with weak suck and Moro;
- Stage 3 (severe): stupor, flaccidity, small to mid position pupils that react poorly to light, decreased stretch reflexes, hypothermia and absent Moro.
- No major congenital abnormalities recognisable at birth.
Types of interventions
Therapeutic cooling (whole body or selective head cooling) initiated prior to six hours after birth versus no cooling (standard care).
Types of outcome measures
Primary outcomes
The primary outcome measure was death or long‐term major neurodevelopmental disability (CP, developmental delay (Bayley or Griffith assessment more than two standard deviations (SD) below the mean) or intellectual impairment (intelligence quotient (IQ) more than two SD below mean), blindness (vision < 6/60 in both eyes), sensorineural deafness requiring amplification). Long‐term outcomes will be reported for all studies that have evaluated children after 18 months’ chronological age. Separate analyses will be performed for children aged 18 to 24 months and > three years.
Secondary outcomes
1. Mortality.
2. Major neurodevelopmental disability (CP, developmental delay (Bayley or Griffith assessment more than two SD below the mean) or intellectual impairment (IQ more than two SD below mean), blindness (vision < 6/60 in both eyes), sensorineural deafness requiring amplification).
Each component of major neurodevelopmental disability:
a) CP;
b) developmental delay or intellectual impairment:
- Bayley or Griffith assessment more than two SD below the mean or intellectual impairment (IQ more than two SD below mean);
- neuromotor development (Bayley Scales of Infant Development ‐ Psychomotor Development Index (BSID PDI)) assessed in survivors;
- mental development (Bayley Scales of Infant Development ‐ Mental Development Index (BSID MDI)) assessed in survivors;
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