Subscribe to RSS
DOI: 10.1055/a-1846-1545
Effect of Therapeutic Hypothermia Treatment on Acute Phase Reactants
![](https://www.thieme-connect.de/media/zgn/202205/lookinside/thumbnails/03-2022-0575_10-1055-a-1846-1545-1.jpg)
Abstract
Objective In our study, we aimed to examine the effect of therapeutic hypothermia treatment on C-reactive protein (CRP) and interleukin-6 (IL-6) in infants with hypoxic ischemic encephalopathy (HIE).
Methods The data of the patients with the diagnosis of HIE we followed up in our unit between 2017 and 2018 were analyzed retrospectively. Patients who died during follow-up and patients with proven septicemia at the time of examination were excluded from the study. The routine CRP and IL-6 values of the patients included in the study were compared before and after hypothermia treatment.
Results Therapeutic hypothermia treatment applied for 72 hours was found to cause a statistically significant increase in CRP after treatment when compared with the values measured before treatment (0.6 (0.2–1.9) before and median (P25–75), and after treatment 7.5 (4–18) and median (P25–75) mg/L, p=0.00). While IL-6 was found to be high in the early period due to the effect of hypoxia, it was found to be low after hypothermia treatment (80.5 (40–200) median (P25–75) – 32 (18–50) median (P25–75) pg/ml, p=0.131). While the white blood cell count was high before hypothermia treatment due to hypoxia, it was found to be low after treatment (24600 (19600–30100) median (P25–75) –11300 (8800–14200) median (P25–75)/µL, p=0.001).
Conclusion White blood cells and IL-6 can be found to be high due to hypoxia without infection, and CRP can be found to be high after therapeutic hypothermia treatment without infection. The effect of hypoxia and hypothermia should be considered when evaluating acute phase reactants.
Key words
Hypoxic ischemic encephalopathy - hypothermia - septicemia - C-reactive protein - interleukin-6Publication History
Received: 11 March 2022
Accepted after revision: 26 April 2022
Article published online:
22 August 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Jacobs SE, Berg M, Hunt R. et al. Cooling for newborns with hypoxic ischemic encephalopathy. Cochrane Database Syst Rev 2013; 2013: Cd003311
- 2 O’Dea M, Sweetman D, Bonifacio SL. et al. Management of multi organ dysfunction in neonatal encephalopathy. Front Pediatr 2020; 8: 239
- 3 Ruhfus M, Giannakis S, Markus M. et al. Association of routinely measured proinflammatory biomarkers with abnormal MRI findings in asphyxiated neonates undergoing therapeutic hypothermia. Front Pediatr 2021; 9: 624652
- 4 Tiozzo C, Mukhopadhyay S. Noninfectious influencers of early-onset sepsis biomarkers. Pediatr Res 2022; 91: 425-431
- 5 Akisu M, Kumral A, Canpolat FE. Turkish Neonatal Society Guideline on neonatal encephalopathy. Turk Pediatri Ars 2018; 53: S32-S44
- 6 Bhalala US, Koehler RC, Kannan S. Neuroinflammation and neuroimmune dysregulation after acute hypoxic-ischemic injury of developing brain. Front Pediatr 2014; 2: 144
- 7 Jenkins DD, Rollins LG, Perkel JK. et al. Serum cytokines in a clinical trial of hypothermia for neonatal hypoxic-ischemic encephalopathy. J Cereb Blood Flow Metab 2012; 32: 1888-1896
- 8 Róka A, Bekő G, Halász J. et al. Changes in serum cytokine and cortisol levels in normothermic and hypothermic term neonates after perinatal asphyxia. Inflamm Res 2013; 62: 81-87
- 9 Muniraman H, Gardner D, Skinner J. et al. Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia. Eur J Pediatr 2017; 176: 1295-1303
- 10 Cilla A, Arnaez J, Benavente-Fernández I. et al. Effect of hypothermia and severity of hypoxic-ischemic encephalopathy in the levels of C-reactive protein during the first 120 hours of life. Am J Perinatol 2020; 37: 722-730
- 11 Saito J, Shibasaki J, Shimokaze T. et al. Temporal relationship between serum levels of interleukin-6 and C-reactive protein in therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy. Am J Perinatol 2016; 33: 1401-1406
- 12 Perrone S, Szabó M, Bellieni CV. et al. Whole body hypothermia and oxidative stress in babies with hypoxic-ischemic brain injury. Pediatr Neurol 2010; 43: 236-240
- 13 Okumuş N, Beken S, Aydın B. et al. Effect of therapeutic hypothermia on C-reactive protein levels in patients with perinatal asphyxia. Am J Perinatol 2015; 32: 667-674
- 14 Chakkarapani E, Davis J, Thoresen M. Therapeutic hypothermia delays the C-reactive protein response and suppresses white blood cell and platelet count in infants with neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2014; 99: F458-F463
- 15 Chiesa C, Signore F, Assumma M. et al. Serial measurements of C-reactive protein and interleukin-6 in the immediate postnatal period: reference intervals and analysis of maternal and perinatal confounders. Clin Chem 2001; 47: 1016-1022
- 16 Perrone S, Lotti F, Longini M. et al. C-reactive protein in healthy term newborns during the first 48 hours of life. Arch Dis Child Fetal Neonatal Ed 2018; 103: F163-F166
- 17 Jenkins DD, Lee T, Chiuzan C. et al. Altered circulating leukocytes and their chemokines in a clinical trial of therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy *. Pediatr Crit Care Med 2013; 14: 786-795
- 18 De Rose DU, Lazzareschi I, Serrao F. et al. Therapeutic hypothermia and leukocytosis in newborns: an unusual association. J Pediatr Hematol Oncol 2020; 42: e759-e761
- 19 Christensen RD, Sheffield MJ, Lambert DK. et al. Effect of therapeutic hypothermia in neonates with hypoxic-ischemic encephalopathy on platelet function. Neonatology 2012; 101: 91-94