Abstract
The neuroprotective efficacy of hypothermia (HT) after hypoxia-ischemia (HI) falls dramatically the longer the delay in initiating HT. Knowledge is scarce regarding protective or adverse effects of HT in organs beyond the brain. In addition, the relative effectiveness of selective head cooling (SHC) and whole body cooling (WBC) has not been studied. We aimed to examine whether 24 h HT, initiated 3 h after global HI is brain- and/or organ-protective using pathology, neurology, and biochemical markers. Fifty, ≤1-d-old pigs were subjected to global HI causing permanent brain injury. Animals were randomized to normothermia (NT), (Trectal) 39.0°C, SHCTrectal 34.5°C, or WBCTrectal 34.5°C for 24 h, all followed by 48 h NT. There was no difference in injury to the brain or organs between groups. There was no gender difference in brain injury but females had significantly more organs injured [2.3 (± 1.3) [mean ± SD] vs. 1.4 ± (1.0)]. The postinsult decline in lactate was temperature independent. However, HT animals normalized their plasma-calcium, magnesium, and potassium significantly faster than NT. Delayed SHC or WBC, initiated 3 h after HI, does not reduce pathology in the brain nor in organs. Delayed HT improves postinsult recovery of plasma-calcium, magnesium, and potassium. There were no differences in adverse effects across groups.
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Abbreviations
- AUC:
-
area under curve
- HI:
-
hypoxia-ischemia
- HIE:
-
hypoxic ischemic encephalopathy
- HT:
-
hypothermia
- IQR:
-
interquartile range
- MABP:
-
mean arterial blood pressure
- MOD:
-
multiorgan dysfunction
- NT:
-
normothermia
- SHC:
-
selective head cooling
- Trectal:
-
rectal temperature
- UVC:
-
umbilical vein catheter
- WBC:
-
whole body cooling
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Acknowledgements
The authors thank the following companies for lending us equipment used in this study; Olympic Medical (CoolCare cooling system), SLE (neonatal ventilator), Radiometer (blood gas machine and co-oximeter) and Datex-Ohmeda (Giraffe incubator).
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This work was supported by The Wellcome Trust (UK), who provided the main funding, along with support from Laerdal Foundation for Acute Medicine (Norway), The Swedish Medical Research Council and Research and Public Health in Värmland.M.K. and J.R.T. contributed equally to this study.
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Karlsson, M., Tooley, J., Satas, S. et al. Delayed Hypothermia as Selective Head Cooling or Whole Body Cooling Does Not Protect Brain or Body in Newborn Pig Subjected to Hypoxia-Ischemia. Pediatr Res 64, 74–80 (2008). https://doi.org/10.1203/PDR.0b013e318174efdd
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DOI: https://doi.org/10.1203/PDR.0b013e318174efdd
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