Surkov D. Neuroresuscitation and neuroprotection in severe hypoxic-ischemic brain injuries for term newborns

The study included the results of the observation and treatment of 205 full-term infants with severe hypoxic-ischemic encephalopathy (P91.6 by ICD-10). The possibility of starting of therapeutic hypothermia in the period over 6 hours after asphyxia at birth was established, the absence of influence of fluctuations of body temperature within 33-35°C on the further development of cerebral leukomalacia (p=0.890) was demonstrated. Advantages of NAVA ventilation over traditional modes were revealed. Statistically higher indices of cerebral blood flow RI (0.70 [0.67-0.74] vs 0.66 [0.58-0.72], p=0.021) and PI were obtained (1.3 [1.2-1.5] vs 1.2 [1.0-1.40], p = 0.032) using NAVA compared with the control group. The possibility of administration of 6% hydroxyethylstarch 130/0,42 in this group of patients was determined. In comparison with normal saline, cerebral oxygenation was higher in the group using 6% HES (rScO2 93 [90-95]% vs 75 [70-87]%, p=0.047). Comparing with dobutamine, a negative effect of dopamine on cerebral perfusion was observed, namely a decreasing of RI (0.66 [0.57-0.71] vs. 0.67 [0.61-0.74], p=0.020) and RI (1.14 [0.9-1.32] vs. 1.22 [1.03-1.43], p=0.010). When comparing the effects of morphine with other sedatives, there was a significant difference between the groups in RI level as in the first (0.64 [0.55-0.74] vs. 0.68 [0.61-0.75], p=0.037) and on the third day of treatment (0.64 [0.55-0.70] vs. 0.67 [0.61-0.75], p=0.040). Prospective data hints that dexmedetomidine patients were significantly more often extubated during 7 days comparing to control group (68% vs. 33%, p=0.018) with HR of 0.48 (95% CI 0.27-0.86, p=0.011). No significant neuroprotective effects of cyticolin used in neonates with HIE were found.