2012 Volume 32 Issue 1 Pages 027-031
Of more than 1,000 neuroprotective treatments proposed in peer-review journals, only therapeutic hypothermia has been promoted into a standard clinical therapy. So far, six phase-III studies of hypothermia for neonatal encephalopathy have successfully demonstrated the neuroprotective effect of the treatment. It is interesting that both selective head cooling and whole body cooling resulted in a similar protective effect despite the temperature difference >10 degrees C in the superficial brain. It would be possible to introduce a dramatic improvement in the protective effect of hypothermia by adjusting parameters such as local brain temperatures and cooling durations.
In contrast, there is a lack of evidence in the protective effect of hypothermia in child encephalopathy, presumably due to a wide variation of pathological backgrounds relative to the limited number of cases. A recent preliminary multi-centre study demonstrated that the delay in cooling initiation led to exponential decline in the outcome scores for children with acute encephalopathy. It was of note that late initiation of hypothermia >12 hours appeared to be deleterious whereas early cooling < 6 hours was associated with favourable outcomes.
Although hypothermia has promise in some clinical conditions, clinical protocols require further improvement; more clinical and translational studies are necessary to yield the optimal protective effect of hypothermia.
