Abstract

Early induced therapeutic hypothermia represents the cornerstone treatment in neonates with probable hypoxic-ischemic encephalopathy. The selection of patients for treatment usually involves meeting criteria indicating evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. In this review, we highlight the variability that exists between some of the different regional and national eligibility guidelines. Determining the potential presence of perinatal hypoxia-ischemia may require either one, two or three signs amongst history of acute perinatal event, prolonged resuscitation at delivery, abnormal blood gases and low Apgar score, with a range of cutoff values. Clinical neurological exams often define the severity of encephalopathy differently, with varying number of domains required for determining eligibility and blurred interpretation of findings assigned to different severity grades in different systems. The role of early electrophysiological assessment is weighted differently. A clinical implication is that infants may receive different care depending on the location in which they are born. This could also impact epidemiological data, as inference of rates of moderate-severe encephalopathy based on therapeutic hypothermia rates are misleading and influenced by different eligibility methods used. We would advocate that a universally endorsed single severity staging of encephalopathy is vital for standardizing management and neonatal outcome.

Impact

• Variability exists between regional and national therapeutic hypothermia eligibility guidelines for neonates with probable hypoxic-ischemic encephalopathy.

• Differences are common in both criteria indicating perinatal hypoxia-ischemia and criteria defining moderate or severe encephalopathy. The role of early electrophysiological assessment is also weighted unequally.

• This reflects in different individual care and impacts research data. A universally endorsed single severity staging of encephalopathy would be crucial for standardizing management.

中文翻译：

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新生儿缺氧缺血性脑病低温治疗资格标准的区域差异

摘要

早期诱导治疗性低温是可能患有缺氧缺血性脑病的新生儿的基石治疗。选择接受治疗的患者通常需要满足围产期缺氧缺血证据和存在中度或重度脑病的标准。在本次审查中，我们强调了一些不同地区和国家资格准则之间存在的差异。确定围产期缺氧缺血的潜在存在可能需要急性围产期事件史、分娩时长时间复苏、异常血气和低阿普加评分（具有一系列截止值）中的一种、两种或三种体征。临床神经学检查通常对脑病的严重程度有不同的定义，确定资格所需的领域数量不同，并且对不同系统中不同严重程度等级的结果解释模糊。早期电生理评估的作用有不同的权重。临床意义是，婴儿可能会根据出生地点的不同而接受不同的护理。这也可能影响流行病学数据，因为根据治疗性低温率推断中重度脑病率具有误导性，并受到所使用的不同资格方法的影响。我们主张，普遍认可的脑病单一严重程度分期对于标准化管理和新生儿结局至关重要。

影响

• 对于可能患有缺氧缺血性脑病的新生儿，地区和国家的低温治疗资格指南之间存在差异。

• 表明围产期缺氧缺血的标准和定义中度或重度脑病的标准之间存在常见差异。早期电生理评估的作用也权重不均。

• 这反映在不同的个人护理和影响研究数据中。普遍认可的脑病单一严重程度分期对于标准化管理至关重要。