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Physiologic and pharmacologic considerations for hypothermia therapy in neonates

Journal of Perinatology volume 31, pages 377–386 (2011)Cite this article

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Abstract

With mounting evidence that hypothermia is neuroprotective in newborns with hypoxic-ischemic encephalopathy (HIE), an increasing number of centers are offering this therapy. Hypothermia is associated with a wide range of physiologic changes affecting every organ system, and awareness of these effects is essential for optimum patient management. Lowering the core temperature also alters pharmacokinetic and pharmacodynamic properties of medications commonly used in asphyxiated neonates, necessitating close attention to drug efficacy and side effects. Rewarming introduces additional risks and challenges as the hypothermia-associated physiologic and pharmacologic changes are reversed. In this review we provide an organ system-based assessment of physiologic changes associated with hypothermia. We also summarize evidence from randomized controlled trials showing lack of serious adverse effects of moderate hypothermia therapy in term and near-term newborns with moderate-to-severe HIE. Finally, we review the effects of hypothermia on drug metabolism and clearance based on studies in animal models and human adults, and limited data from neonates.

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Authors and Affiliations

  1. Department of Pediatrics, University of Virginia, Charlottesville, VA, USA

    S Zanelli, M Buck & K Fairchild

  2. Department of Pharmacy, University of Virginia, Charlottesville, VA, USA

    M Buck

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  1. S Zanelli
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  2. M Buck
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Correspondence to S Zanelli.

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Zanelli, S., Buck, M. & Fairchild, K. Physiologic and pharmacologic considerations for hypothermia therapy in neonates. J Perinatol 31, 377–386 (2011). https://doi.org/10.1038/jp.2010.146

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