Perinatal asphyxia remains a major cause of morbidity and mortality throughout the world. Despite improvements in obstetric and neonatal care there has been little improvement in rates of death and disability. Therapeutic hypothermia has recently been shown to be the only effective treatment following perinatal asphyxia. Selective Head Cooling (SHe) and Whole Body Cooling (WBe) are methods of applying therapeutic hypothermia. Yet the optimum method of cooling for maximum neuroprotection and minimum adverse effects remains unclear. We retrospectively compared four methods of cooling newborns following perinatal asphyxia. One method of SHC and three methods of WBC, using water-filled gloves, a coolant- filled mattress, and a water- filled body wrap. All methods maintained rectal t emperature within narrow target range. We found that WBC using a servo- controlled system minimised initial over-cooling and reduced subsequent fluctuation in rectal t emperature compared with manually-controlled WBC or SHe. We found similar variation in rectal temperature, heart rate, and mean arterial blood pressure using SHC and manually controlled WBe. We developed a technique of applying SHC with minimal systemic hypothermia as a t reatment for perinatal asphyxia in our established experimental model. We conducted a study to assess the neuroprotective and physiological effects of our technique compared to standard care under normothermic conditions. We did not find any difference in brain injury between treatment groups but increased mortality in the hypothermia group. We have.previously used a neuropathology score in our established model of perinatal asphyxia in order to assess treatment effects. Our neuropathology score incorporates subjective assessments of area injure'd and morphological cellular changes in several brain regions. We conducted quantitative cell counting to assess brain injury following perinatal asphyxia. Cell count correlated with neuropathology score in the putamen and hippocampus CA1 and we were able to validate our neuropathology score to assess outcome.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:654564 |
| Date | January 2014 |
| Creators | Hoque, Nicholas Nadir |
| Publisher | University of Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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