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zoom RSS 低体温療法で新生児脳障害のリスクを軽減

<<   作成日時 : 2009/10/05 21:36   >>

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画像 軽度の低体温療法により、新生児の低酸素性脳障害のリスクを軽減できる可能性があるとの研究。
 英国と他の5ヶ国の33病院で300人の新生児について研究が行われた。満期出生の成熟児の低酸素性脳症に対して低体温療法を行うと57%脳障害なしで生き残る確率が高くなる。低体温マットにより体温を4℃下げ、代謝を抑えて出産時の脳障害を減らし時間をかせぐことによると考えられている。
 全ての新生児に有効というわけではないが、低体温にすることで、脳障害なしで生き残った乳児の割合が28%から44%へと57%増加した。新生児集中治療室NICUで72時間の間33-34℃(91-93F)まで冷やす。
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Page last updated at 21:07 GMT, Wednesday, 30 September 2009 22:07 UK
Cooling 'cuts baby brain damage'
By Fergus Walsh
Medical correspondent, BBC News
http://news.bbc.co.uk/2/hi/health/8283738.stm

画像Baby on cooling mat
This two-day-old baby is being cooled after being starved of oxygen...

Babies who are starved of oxygen at birth have a much lower risk of brain damage if they are given mild hypothermia, major research suggests.

More than 300 babies were involved in a trial carried out at 33 hospitals in the UK and in five other countries.

Researchers found full-term babies who suffered oxygen loss at birth were 57% more likely to survive without brain damage if their bodies were cooled.

The findings are published in the New England Journal of Medicine.

The babies' body temperature was brought down by about 4C using a fluid-filled mat under their sheet.

Doctors are not exactly sure why it helps, but think that slowing their metabolism reduces the after-shocks of the birth trauma, giving the brain time to recover.

Starved of oxygen

Dr Denis Azzopardi, from Imperial College London and who led the trial, said: "The study builds on a 20-year body of research but gives, for the first time, irrefutable proof that cooling can be effective in reducing brain damage after birth asphyxia.

"Although unfortunately it doesn't work in every case, our study showed the proportion of babies that survived without signs of brain damage went from 28% to 44% with cooling treatments - that's a 57% increase."

Fergus Walsh is shown the cooling mat by co-chief investigator Dr Denis Azzopardi

Carmel Bartley, Family Support Manager from the children's charity Bliss, said: "This is very welcome research into an area which is known to save lives. Cooling of babies with birth asphyxia is an innovative technique already being used in some neonatal centres.

"This is a specialist treatment that we would like to see used more widely to ensure the very best outcomes for our most vulnerable babies."

The trial involved 325 full-term babies who had been starved of oxygen at birth.

Half of the newborn babies had their body temperature reduced to 33-34C (91-93F) for 72 hours followed by gradual re-warming in intensive care. Normal body temperature is around 37C (98F).

The study received nearly £1m of funding from the Medical Research Council and mostly involved hospitals in the UK, plus neonatal units in Ireland, Sweden Finland, Hungary and Israel.

Over to NICE

Becca Gallogly's daughter Emma is one of the babies in the group that was cooled. Emma is a bright and active four-year-old but when she was born she was dangerously ill after suffering oxygen loss.

Emma
Emma is now a bright and active four-year-old

Becca says she feels very fortunate that Emma is well: "Every day I thank my lucky stars that we've been as lucky as we have.

"For the first two years of her life we felt we were wishing a lot of it away, because we were so anxious for her to meet her next milestone and see how she developed.

"We were looking for problems and thankfully there weren't any."

The trial data will now be assessed by the National Institute for Health and Clinical Excellence (NICE) to see whether the technique should be rolled out to all neonatal units.

----------------------------------------------------
NEJM Volume 361:1349-1358, October 1, 2009, Number 14

Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy


Denis V. Azzopardi, F.R.C.P.C.H., Brenda Strohm, R.G.N., A. David Edwards, F.Med.Sci., Leigh Dyet, M.B., B.S., Ph.D., Henry L. Halliday, F.R.C.P.H., Edmund Juszczak, M.Sc., Olga Kapellou, M.D., Malcolm Levene, F.Med.Sci., Neil Marlow, F.Med.Sci., Emma Porter, M.R.C.P.C.H., Marianne Thoresen, M.D., Ph.D., Andrew Whitelaw, F.R.C.P.C.H., Peter Brocklehurst, F.F.P.H., for the TOBY Study Group

ABSTRACT

Background
Whether hypothermic therapy improves neurodevelopmental outcomes in newborn infants with asphyxial encephalopathy is uncertain.

Methods
We performed a randomized trial of infants who were less than 6 hours of age and had a gestational age of at least 36 weeks and perinatal asphyxial encephalopathy. We compared intensive care plus cooling of the body to 33.5°C for 72 hours and intensive care alone. The primary outcome was death or severe disability at 18 months of age. Prespecified secondary outcomes included 12 neurologic outcomes and 14 other adverse outcomes.

Results Of 325 infants enrolled, 163 underwent intensive care with cooling, and 162 underwent intensive care alone. In the cooled group, 42 infants died and 32 survived but had severe neurodevelopmental disability, whereas in the noncooled group, 44 infants died and 42 had severe disability (relative risk for either outcome, 0.86; 95% confidence interval [CI], 0.68 to 1.07; P=0.17). Infants in the cooled group had an increased rate of survival without neurologic abnormality (relative risk, 1.57; 95% CI, 1.16 to 2.12; P=0.003). Among survivors, cooling resulted in reduced risks of cerebral palsy (relative risk, 0.67; 95% CI, 0.47 to 0.96; P=0.03) and improved scores on the Mental Developmental Index and Psychomotor Developmental Index of the Bayley Scales of Infant Development II (P=0.03 for each) and the Gross Motor Function Classification System (P=0.01). Improvements in other neurologic outcomes in the cooled group were not significant. Adverse events were mostly minor and not associated with cooling.

Conclusions
Induction of moderate hypothermia for 72 hours in infants who had perinatal asphyxia did not significantly reduce the combined rate of death or severe disability but resulted in improved neurologic outcomes in survivors. (Current Controlled Trials number, ISRCTN89547571 [controlled-trials.com] .)

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