Child's Health · Published 2025-12-01 · DOI 10.22141/2224-0551.20.7.2025.1920
Background. Birth asphyxia remains the third leading cause of neonatal mortality (23 %) and is associated with a nearly equivalent incidence of severe neurological impairment. Therapeutic hypothermia (TH) is an effective and safe treatment strategy for term infants, reducing the combined risk of death or major disability at 18 months of age. However, more than 40 % of infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) still develop long-term adverse outcomes. Modern scientific publications are primarily focused on the issues of predicting brain damage in the context of therapeutic hypothermia. Predicting the outcomes of HIE at the present stage is based on combinations of clinical and laboratory parameters, such as the combined Multiorgan Dysfunction Evaluation (MODE) score. Nonetheless, individual indicators remain important, and their spectrum continues to expand. Thermoregulation assessment has emerged as a promising marker for outcome prediction, as it reflects the extent of brain injury. Higher body temperature in infants during TH has been associated with adverse neurodevelopmental outcomes at 18 months of age. Therefore, the purpose of our study was to test the hypothesis that infants with severe adverse outcomes of HIE exhibit impaired thermoregulation — manifested by fluctuations in axillary temperature after the completion of TH — within the first 10 days of life. Materials and methods. The study was conducted at the Neonatal Center and the Follow-up Observation Center of the Regional Medical Center for Family Health at the Dnipro Regional Council. The research design was defined as a retrospective, single-center clinical study. The study cohort included 19 children who had received device-controlled systemic TH as part of their neonatal management for post-asphyxial encephalopathy during 2023–2024 and had reached two years of age. Data concerning the neonatal period were obtained through the analysis of medical records. The degree of post-asphyxial multiorgan dysfunction was assessed using the MODE score, which encompassed evaluation of the neurological, cardiovascular, respiratory, gastrointestinal, and renal systems, as well as hematologic parameters, neuroimaging findings, and electroencephalographic characteristics. During TH, body temperature was monitored continuously via a rectal sensor; after hypothermia, axillary temperature was assessed up to the 10th day of life, with measurements performed every two hours. Results. Among the 19 infants examined (10 males and 9 females), 5 children (26.3 %) demonstrated severe adverse outcomes of HIE. They significantly differed (p < 0.05) from those without such outcomes in several key parameters. The frequency of advanced resuscitation measures, specifically the need for pharmacologic interventions during initial resuscitation, was markedly higher (80.0 vs. 21.4 %). These infants also exhibited more pronounced multiorgan dysfunction, as reflected by higher MODE scores: 8 (6–9) vs. 2 (1–3), and showed a greater incidence of temperature instability following TH, with episodes of axillary temperature elevation within the first 10 days of life observed in all affected infants (100.0 vs. 21.4 %). The occurrence of temperature elevation episodes during the first 10 days of life demonstrated significant correlations (p < 0.05) with several clinical parameters such as the need for advanced resuscitation (rs = 0.671), the degree of post-asphyxial multiorgan dysfunction according to the MODE score (rs = 0.673), presence of seizures (rs = 0.610), pathological muscle tone abnormalities (rs = 0.585) or absence of oral feeding at discharge (rs = 0.507), and destructive changes in brain tissue on neuroimaging (rs = 0.701). Signs of infection emerging within the first 10 days of life were identified in 1 infant (7.1 %) in the group without adverse outcomes and in 2 infants (40.0 %) in the group with adverse outcomes (p = 0.155). Thermoregulatory disorders predicted severe long-term outcomes with good diagnostic accuracy according to the ROC curve analysis (AUC = 0.893), whereas the MODE score demonstrated excellent diagnostic accuracy (AUC = 0.993). Both indicators achieved 100 % sensitivity at their optimal thresholds; however, specificity was higher for the MODE score (0.929 vs. 0.786). Conclusions. Our findings support the hypothesis that infants with severe adverse outcomes of HIE following TH exhibit impaired thermoregulation — manifested as elevated skin temperature during continued post-hypothermia temperature monitoring — within the first 10 days of life. Both evaluated parameters, the MODE score and manifestations of thermoregulatory disorders, demonstrated 100 % sensitivity for predicting severe adverse outcomes of HIE. However, the MODE score showed superior specificity for prognostic purposes. Further studies are needed to investigate whether episodes of temperature change after TH are associated with adverse outcomes of HIE.
Abstract from DOAJ. Public domain (CC0 1.0).
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