Effects of hypothermia for perinatal asphyxia on childhood outcomes

Denis Azzopardi, Brenda Strohm, Neil Marlow, Peter Brocklehurst, Aniko Deierl, Oya Eddama, Julia Goodwin, Henry L. Halliday, Edmund Juszczak, Olga Kapellou, Malcolm Levene, Louise Linsell, Omar Omar, Marianne Thoresen, Nora Tusor, Andrew Whitelaw, A. David Edwards

Research output: Contribution to journalArticle

272 Citations (Scopus)

Abstract

BACKGROUND: In the Total Body Hypothermia for Neonatal Encephalopathy Trial (TOBY), newborns with asphyxial encephalopathy who received hypothermic therapy had improved neurologic outcomes at 18 months of age, but it is uncertain whether such therapy results in longer-term neurocognitive benefits. METHODS: We randomly assigned 325 newborns with asphyxial encephalopathy who were born at a gestational age of 36 weeks or more to receive standard care alone (control) or standard care with hypothermia to a rectal temperature of 33 to 34°C for 72 hours within 6 hours after birth. We evaluated the neurocognitive function of these children at 6 to 7 years of age. The primary outcome of this analysis was the frequency of survival with an IQ score of 85 or higher. RESULTS: A total of 75 of 145 children (52%) in the hypothermia group versus 52 of 132 (39%) in the control group survived with an IQ score of 85 or more (relative risk, 1.31; P=0.04). The proportions of children who died were similar in the hypothermia group and the control group (29% and 30%, respectively). More children in the hypothermia group than in the control group survived without neurologic abnormalities (65 of 145 [45%] vs. 37 of 132 [28%]; relative risk, 1.60; 95% confidence interval, 1.15 to 2.22). Among survivors, children in the hypothermia group, as compared with those in the control group, had significant reductions in the risk of cerebral palsy (21% vs. 36%, P=0.03) and the risk of moderate or severe disability (22% vs. 37%, P=0.03); they also had significantly better motor-function scores. There was no significant between-group difference in parental assessments of children's health status and in results on 10 of 11 psychometric tests. CONCLUSIONS: Moderate hypothermia after perinatal asphyxia resulted in improved neurocognitive outcomes in middle childhood.

Original languageEnglish
Pages (from-to)140-149
Number of pages10
JournalNew England Journal of Medicine
Volume371
Issue number2
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

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Asphyxia
Hypothermia
Brain Diseases
Control Groups
Newborn Infant
Nervous System Malformations
Cerebral Palsy
Risk Reduction Behavior
Psychometrics
Nervous System
Health Status
Gestational Age
Survivors
Parturition
Confidence Intervals
Temperature
Survival
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Azzopardi, D., Strohm, B., Marlow, N., Brocklehurst, P., Deierl, A., Eddama, O., ... Edwards, A. D. (2014). Effects of hypothermia for perinatal asphyxia on childhood outcomes. New England Journal of Medicine, 371(2), 140-149. https://doi.org/10.1056/NEJMoa1315788

Effects of hypothermia for perinatal asphyxia on childhood outcomes. / Azzopardi, Denis; Strohm, Brenda; Marlow, Neil; Brocklehurst, Peter; Deierl, Aniko; Eddama, Oya; Goodwin, Julia; Halliday, Henry L.; Juszczak, Edmund; Kapellou, Olga; Levene, Malcolm; Linsell, Louise; Omar, Omar; Thoresen, Marianne; Tusor, Nora; Whitelaw, Andrew; Edwards, A. David.

In: New England Journal of Medicine, Vol. 371, No. 2, 01.01.2014, p. 140-149.

Research output: Contribution to journalArticle

Azzopardi, D, Strohm, B, Marlow, N, Brocklehurst, P, Deierl, A, Eddama, O, Goodwin, J, Halliday, HL, Juszczak, E, Kapellou, O, Levene, M, Linsell, L, Omar, O, Thoresen, M, Tusor, N, Whitelaw, A & Edwards, AD 2014, 'Effects of hypothermia for perinatal asphyxia on childhood outcomes', New England Journal of Medicine, vol. 371, no. 2, pp. 140-149. https://doi.org/10.1056/NEJMoa1315788
Azzopardi D, Strohm B, Marlow N, Brocklehurst P, Deierl A, Eddama O et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes. New England Journal of Medicine. 2014 Jan 1;371(2):140-149. https://doi.org/10.1056/NEJMoa1315788
Azzopardi, Denis ; Strohm, Brenda ; Marlow, Neil ; Brocklehurst, Peter ; Deierl, Aniko ; Eddama, Oya ; Goodwin, Julia ; Halliday, Henry L. ; Juszczak, Edmund ; Kapellou, Olga ; Levene, Malcolm ; Linsell, Louise ; Omar, Omar ; Thoresen, Marianne ; Tusor, Nora ; Whitelaw, Andrew ; Edwards, A. David. / Effects of hypothermia for perinatal asphyxia on childhood outcomes. In: New England Journal of Medicine. 2014 ; Vol. 371, No. 2. pp. 140-149.
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AU - Strohm, Brenda

AU - Marlow, Neil

AU - Brocklehurst, Peter

AU - Deierl, Aniko

AU - Eddama, Oya

AU - Goodwin, Julia

AU - Halliday, Henry L.

AU - Juszczak, Edmund

AU - Kapellou, Olga

AU - Levene, Malcolm

AU - Linsell, Louise

AU - Omar, Omar

AU - Thoresen, Marianne

AU - Tusor, Nora

AU - Whitelaw, Andrew

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