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DOI: 10.1055/s-0029-1241872
© Georg Thieme Verlag KG Stuttgart · New York
Pulmonary Hypertensive Crisis Requiring ECMO Associated with Re-warming from whole Body Hypothermia for Hypoxic Ischemic Encephalopathy: Clinical Observations from a Case Series
Publication History
Publication Date:
28 October 2009 (online)
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Introduction
Hypothermia reduces the risk of death and/or disability in infants with moderate to severe hypoxic ischemic encephalopathy (HIE) [1]. Due to its apparent safety/efficacy, this technique is gaining in popularity. While pulmonary hypertension (PHTN) is a known potential risk associated with hypothermia (20–30%) [2], the associated frequency may be higher than previously described.
Our center routinely treats patients with moderate to severe HIE with hypothermia according to a previously published protocol [3]. Since December 2005, approximately 30 infants have been treated at our center. This communication describes our clinical observation of a higher than expected occurrence of severe pulmonary hypertensive crisis requiring extracorporeal membrane oxygenation (ECMO) associated with re-warming from whole body hypothermia.
References
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- 2 Gluckman PD, Wyatt JS, Azzopardi D. et al . Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: Multicentre randomised trial. Lancet. 2005; 365 663-670
- 3 Shankaran S, Laptook A, Wright LL. et al . Whole-body hypothermia for neonatal encephalopathy: Animal observations as a basis for a randomized, controlled pilot study in term infants. Pediatrics. 2002; 110 377-385
- 4 Jacobs S, Hunt R, Tarnow-Mordi W. et al . Cooling for newborns with hypoxic ischaemic encephalopathy (review). Cochrane Database Syst Rev. 2007; 4 CD003311
- 5 Eicher DJ, Wagner CL, Katikaneni LP. et al . Moderate hypothermia in neonatal encephalopathy: Safety outcomes. Pediatr Neurol. 2005; 32 18-24
- 6 Shankaran S, Pappas A, Laptook AR. et al . Outcomes of safety and effectiveness in a multicenter randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatrics. 2008; 122 e791-e798
- 7 Stoll BJ, Kliegman RM. Nervous system disorders. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics 17th ed. Philadelphia: Saunders 2004: 561-569
- 8 Thoresen M, Whitelaw A. Cardiovascular changes during mild therapeutic hypothermia and rewarming in infants with hypoxic-ischemic encephalopathy. Pediatrics. 2000; 10 92-99
Correspondence
Dr. Charles S. Cox Jr
University of Texas Medical School at Houston
Department of Pediatric Surgery
6431 Fannin Street, MSB 5.236
Houston, TX 77030
United States
Phone: +1713 500 7307
Fax: +1713 500 7296
Email: charles.s.cox@uth.tmc.edu