Laponog S. Optimization of treatment hypoxic-ischemic encephalopathy central nervous system in neonates undergoing selective head cooling.

The dissertation elucidates the safety and efficacy of selective head cooling (SHC) in birth-asphyxiated term infants. It has been ascertained that the use of selective head cooling in birth-asphyxiated term infants decrease in mortality without significant increasing major neurodevelopmental disability at the age of 12 - 18 months. The aEEG proves to be extremely useful to define the current condition of the central nervous system suffering from severe asphyxia. Upper margin of aEEG activity higher than 25 µV soon after birth was associated with favourable outcome. Established discontinuous normal voltage (DNV) aEEG pattern appearance later than 149 hours after the start of cooling suggests unfavorable outcome, rise of normal sleep-wake cycle (nSWC) before 144 hours after start of cooling suggests favorable outcome. During selective head cooling (SHC) in birth-asphyxiated term infants the event of bradycardia has been noticed as well as considerable dependence of a newborn on sympathomimetic treatment. It has been proved that the hypothermia treatment presented more expressed thrombocytopenia in comparison with the normothermia group. Time of appearance of the sucking reflex may be useful to predict outcome of hypoxic-ischemic encephalopathy. No correlation is found between the start time of cooling (within 6 hours) and possible unfavourable outcome at the age of 12 - 18 months