Background To compare the outcomes of whole-body hypothermia (WBH) in infants with neonatal encephalopathy born at 340/7-356/7 versus 360/7-376/7 weeks’ gestation. Methods Retrospective analysis of 122 outborn infants in a single unit: Group 1 (n = 63; 340/7-6/7 weeks n = 17, 350/7-6/7 weeks n = 46) and Group 2 (n = 59; 360/7-6/7 weeks n = 25, 370/7-6/7 weeks n = 34). Clinical, electrographic, neuroimaging, neurodevelopmental data at 18 months were assessed. Results Group 1 had more hemodynamic instability (67% vs. 32%, p < 0.001), hypoglycemia (54% vs 36%, p = 0.04), and higher white-matter and total brain-injury scores (medians 7 vs. 4 and 10 vs. 5, both p ≤ 0.05), compared with Group 2. Overall mortality was 22% (14/63) vs. 12% (7/59), respectively (adjusted odds ratio [aOR] 3.49, 95% CI 1.06–11.50). Composite outcome of death or moderate-severe neurodevelopmental impairment (NDI) was more common in Group 1 (42% vs. 21%; aOR 2.94, 95% CI 1.02–8.46). The 350/7-6/7 vs. 360/7-6/7-week subgroup comparison did not reach statistical significance for composite outcome (aOR 2.42, 95% CI 0.60–9.78, p = 0.2). However, among 350/7-6/7-week infants, composite outcome was more common occurring in 45% compared with 21% at 360/7–376/7 weeks (aOR 3.37, 95% CI 1.09–10.44, p = 0.03). Conclusion At 340/7–356/7 weeks, WBH was associated with greater physiological instability, more severe brain injury, and adverse outcomes. Impact <UnorderedList Mark="Bullet"> <ItemContent> Late preterm infants born at 340/7–356/7 weeks’ gestation had higher rates of physiological instability, including hemodynamic instability and hypoglycemia during whole-body hypothermia compared to those born at 360/7–376/7 weeks. </ItemContent> <ItemContent> Post-rewarming brain MRI showed higher white matter injury subscores and total brain injury scores in infants born at 340/7–356/7 weeks’ gestation compared to those born at 360/7–376/7 weeks. </ItemContent> <ItemContent> After adjustment for encephalopathy severity, 340/7–356/7 weeks’ gestation late preterm infants had higher mortality and nearly twice the rate of composite adverse outcomes, highlighting their greater vulnerability to adverse outcomes following whole-body hypothermia compared with the more mature 360/7–376/7 weeks group. </ItemContent> </UnorderedList>

Whole-body hypothermia in late preterm and early term infants: a retrospective analysis from a neurocritical care unit

期刊论文
发表日期：

2026年1月7日

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Alejandra Martinez,
Gokalp Cikman,
Heeba Al Kalaf,
Diane Wilson,
Benjamin Banh,
Wael Abdelmageed,
Ignacio Beamonte Arango,
Rhandi Christensen,
Helen M. Branson,
Mehmet N. Cizmeci

摘要

Background

To compare the outcomes of whole-body hypothermia (WBH) in infants with neonatal encephalopathy born at 34^0/7-35^6/7 versus 36^0/7-37^6/7 weeks’ gestation.

Methods

Retrospective analysis of 122 outborn infants in a single unit: Group 1 (n = 63; 34^0/7-6/7 weeks n = 17, 35^0/7-6/7 weeks n = 46) and Group 2 (n = 59; 36^0/7-6/7 weeks n = 25, 37^0/7-6/7 weeks n = 34). Clinical, electrographic, neuroimaging, neurodevelopmental data at 18 months were assessed.

Results

Group 1 had more hemodynamic instability (67% vs. 32%, p < 0.001), hypoglycemia (54% vs 36%, p = 0.04), and higher white-matter and total brain-injury scores (medians 7 vs. 4 and 10 vs. 5, both p ≤ 0.05), compared with Group 2. Overall mortality was 22% (14/63) vs. 12% (7/59), respectively (adjusted odds ratio [aOR] 3.49, 95% CI 1.06–11.50). Composite outcome of death or moderate-severe neurodevelopmental impairment (NDI) was more common in Group 1 (42% vs. 21%; aOR 2.94, 95% CI 1.02–8.46). The 35^0/7-6/7 vs. 36^0/7-6/7-week subgroup comparison did not reach statistical significance for composite outcome (aOR 2.42, 95% CI 0.60–9.78, p = 0.2). However, among 35^0/7-6/7-week infants, composite outcome was more common occurring in 45% compared with 21% at 36^0/7–37^6/7 weeks (aOR 3.37, 95% CI 1.09–10.44, p = 0.03).

Conclusion

At 34^0/7–35^6/7 weeks, WBH was associated with greater physiological instability, more severe brain injury, and adverse outcomes.

Impact

Late preterm infants born at 34^0/7–35^6/7 weeks’ gestation had higher rates of physiological instability, including hemodynamic instability and hypoglycemia during whole-body hypothermia compared to those born at 36^0/7–37^6/7 weeks.

Post-rewarming brain MRI showed higher white matter injury subscores and total brain injury scores in infants born at 34^0/7–35^6/7 weeks’ gestation compared to those born at 36^0/7–37^6/7 weeks.

After adjustment for encephalopathy severity, 34^0/7–35^6/7 weeks’ gestation late preterm infants had higher mortality and nearly twice the rate of composite adverse outcomes, highlighting their greater vulnerability to adverse outcomes following whole-body hypothermia compared with the more mature 36^0/7–37^6/7 weeks group.