2013-03-11 1 Overview of Hypothermia In Perinatal Asphyxia IPOKRATES – Cracow, Poland Jerome Y. Yager MD Professor of Pediatric Neurosciences Director of Research Department of Pediatrics Stollery Children’s Hospital University of Alberta • Historical Background • Support in Research • Overview of Clinical Trials • Mechanisms of Improvement • Future Directions Objectives Take Home Messages Hypothermia is currently the only accepted and proven effective therapy for hypoxic-ischemic brain injury However, it is incompletely effective and incompletely understood Future directions are clearly moving towards combination chemotherapy (Cocktails & Ice) What about Hypothermia and….. Prematurity? Neonatal Stroke?
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2013-03-11
1
Overview of Hypothermia In
Perinatal Asphyxia
IPOKRATES – Cracow, Poland
Jerome Y. Yager MD Professor of Pediatric Neurosciences
Director of Research Department of Pediatrics
Stollery Children’s Hospital University of Alberta
• Historical Background • Support in Research • Overview of Clinical Trials • Mechanisms of Improvement
• Future Directions
Objectives
Take Home Messages
§ Hypothermia is currently the only accepted and proven effective therapy for hypoxic-ischemic brain injury
§ However, it is incompletely effective and incompletely understood
§ Future directions are clearly moving towards combination chemotherapy (Cocktails & Ice)
§ What about Hypothermia and….. § Prematurity? Neonatal Stroke?
2013-03-11
2
Historical Background
• Very Old Idea – 300 years ago, John Floyer suggested that babies might fare better if they were a little cold after birth.
• Modern hypothermia in clinical practice began in the
30’s and 40’s with the recognition of the successful resuscitation of near drowning victims.
• Deep hypothermia became standard of care in neurosurgical and cardiovascular procedures (aneurysm repair, CHD repair).
Historical Background • In the newborn – studies in the 50’s and 60’s,
particularly in preterm infants, who were exposed to cold environments for prolonged periods resulted in • Increased mortality • Cardiovascular compromise • Coagulation Defects
• This resulted in the promotion of thermoregulation and the maintenance of ‘normal’ temperatures.
Historical Background • Resurrection of mild hypothermia as a neuroprotectant
arose in adult animal models of stroke which showed that:
• Reductions of temperature by 2-4C during hypoxia-ischemia was profoundly neuroprotective.