REVIEW

Permissive Hypothermia as a Reducing Measure for Neurosurgical Intervention in Hypoxic-Ischemic Encephalopathy in Neonates: a robust metanalysis in pediatric neurosurgery

Hipotermia Permissiva como Medida Redutora de Intervenção Neurocirúrgica na Encefalopatia Hipóxico-Isquêmica em Neonatos: uma robusta metanálise em neurocirurgia pediátrica

  • Bianca Frigo Pires    Bianca Frigo Pires
  • Felipe Kenji Ito    Felipe Kenji Ito
  • Danielle Simha Ghiberti    Danielle Simha Ghiberti
  • Alana Camera Bloise Pieroni    Alana Camera Bloise Pieroni
  • Tainan Lima Borges    Tainan Lima Borges
  • Hugo Belavenuta Pinto    Hugo Belavenuta Pinto
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Resumo

Introdução: a encefalopatia hipóxico-isquêmica (EHI) é um subtipo de encefalopatia neonatal cuja causa é uma limitação do oxigênio e do fluxo sanguíneo próximo ao momento do nascimento, sendo uma das principais causas de morte neonatal com comprometimento neurológico de longo prazo. Objetivo: fornecer uma referência para o diagnóstico e tratamento da encefalopatia hipóxico-isquêmica com o objetivo de reduzir a necessidade de intervenção neurocirúrgica ou de melhorar o prognóstico. Métodos: Busca com base no método PRISMA, artigos relacionados a “hipotermia permissiva; lesão cerebral hipóxica; neonatos com hipotermia” publicados nos últimos 5 anos. Resultados: o prognóstico dos pacientes foi óbito em 466 (13%) dos casos e 2066 (48,71%) com lesão cerebral, dentre os quais 76,29% não foram tratados com hipotermia em momento oportuno. Discussão: A EHI tem natureza dinâmica, sendo sua evolução um desafio para a tomada de decisão clínica precoce e pragmática. Por outro lado, estudos recentes têm demonstrado que a cautela excessiva em não utilizar hipotermia permissiva aumentou a progressão das encefalopatias para níveis mais graves. Conclusão: Esta revisão sistemática e meta-análise confirmam que a hipotermia permissiva é uma intervenção eficaz na redução da necessidade de intervenções neurocirúrgicas em neonatos com encefalopatia hipóxico-isquêmica. Além disso, o tratamento reduz a mortalidade e a gravidade da lesão cerebral, levando a melhores resultados de neurodesenvolvimento.

Palavras-chave

Hipotermia permissiva; Lesão cerebral hipóxica; Hipotermia, neonatos

Abstract

Introduction: hypoxic ischemic encephalopathy (HIE) is a subtype of neonatal encephalopathy whose cause is a limitation of oxygen and blood flow close to the moment of birth, being one of the main causes of neonatal death with long-term neurological impairment. Objective: to provide a reference for the diagnosis and treatment of hypoxic-ischemic encephalopathy aiming to reduce the need for neurosurgical intervention or improve prognosis. Methods: Search based on the PRISMA method, articles related to “permissive hypothermia; hypoxic brain injury; neonates with hypothermia” published in the last 5 years were identified. Results: the patients’ prognosis was death in 466 (13%) of cases and brain injury for 2066 (48.71%), among which 76.29% were not treated with HT at an opportune time. Discussion: HIE has a dynamic nature, its evolution being a challenge for early and pragmatic clinical decision-making. On the other hand, recent studies have demonstrated that excessive caution in not using permissive hypothermia increased the progression of encephalopathies to more severe levels. Conclusion: This systematic review and meta-analysis confirm that permissive hypothermia is an effective intervention in reducing the need for neurosurgical interventions in neonates with hypoxic-ischemic encephalopathy. In addition, the treatment reduces mortality and severity of brain injury, leading to improved neurodevelopmental outcomes.

Keywords

Permissive hypothermia; Hypoxic brain injury; Hypothermia neonates

References

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1Faculdade de Medicina de Marília, Marília, SP, Brazil.

2Pediatric Intensive Care Medicine, Faculdade de Medicina de Marília, Marília, SP, Brazil.

 

Received Oct 8, 2024

Accepted Dec 2, 2024

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JBNC  Brazilian Journal of Neurosurgery

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