Abstract Ref Number = APCP1000
Hypothermia (cooling) therapy for Hypoxic Ischemic Encephalopathy (HIE) neonates in Pasar Minggu district hospital A Case report
YuliantoSantoso Kurniawan,SitiUmniyatul Azkiah,Hardwiyani hardwiyani,Indria Febriani
private Pasar Minggu District Hospital
Background : Hypoxic ischemic encephalopathy is one of devastating complication of difficult labor. High mortality and long term neurological sequele frequently follow HIE case. Hypothermia therapy become one of promising therapy in HIE cases.
Case Presentation Summary : A term baby, 3,080 gram, 38 weeks gestational age, born with breech presentation. The APGAR score were 1 in first minute and 3 in 5 minute and 5 in 10 minute. The baby was resusitated and intubated. Patient were diagnose with HIE based on 3 criteria: ventilated since birth, <5 Apgar score after 10 minutes and blood gas examination base excess were -15,8 (>-12). Thompson score was 9 and met indication for cooling therapy. Cooling therapy was initiate in 6 hours after birth. BlanketrollR was used to control core temperature. Patient temperature was lowered to 33-34oC and maintained for 72 hours follow by rewarming period. During cooling therapy patient have had reactive hyperglycemia (575 mg/dL), seizure, prolong PT/aPTT/INR (43,9/109,3 seconds/5,56), low cardiac output and sepsis. Patient were treated with insulin, anti-seizure (midazolam-phenytoin-phenobarbital), fresh frozen plasma and cryoprecipitate transfusion, dopamine and antibiotic (meropenem). Hyperglycemia was controlled in 48 hours, midazolam tappered off and continued with phenitoin-phenobarbital. Patient disharged in 30th days of hospitalization. In 3 month follow up, patient have good weight gain and no sign of spastic or hypotonus.
Learning Points/Discussion : Difficult labor and HIE can found in district hospital. Cooling therapy can be initiated in district hospital. Complication arise in cooling therapy can be manage in district hospital. Cooling therapy for HIE should be disseminated to all pediatrician in NICU district hospital to improve neonatal survival and health care.
Keywords: cooling hypothermia therapy hypoxic ischemic encephalopathy outcome