LAUSR

BACKGROUND: Hypoxic-ischemic (HI) brain injury is one of the most common neurological problems observed in infants. Hypothermia is the only approved therapy for neonatal HI encephalopathy. This therapy is only partially protective, cannot be used in preterm infants, and has a narrow therapeutic window after birth. Therefore, additional adjunctive therapies are urgently required. IAIPs are naturally plasma-derived proteins. We have previously shown that IAIP alone reduces cortical neuronal cell death, improves behavior outcomes, and attenuates brain volume loss in neonatal HI rats (Chen et al., 2019; Schuffels et al., 2020). However, the therapeutic effects of the combined treatment of IAIPs with hypothermia have not been previously established in neonatal rats. PURPOSE: To examine the effects of combined treatment of IAIPs with hypothermia on brain infarct volumes after exposure to HI insults in male and female neonatal rats. The was to carotid Hypothermia neuroprotective fi of neonates at suf ciently on pH, base de fi cit and The AAMBI to de fi ne a set of metabolomic biomarkers best suited to identify infants that might bene fi t from neuroprotective interventions. of neonatal short-term clinical of the AAMBI cohort the of between June 2016 and February 2019. Data on maternal and infant characteristics, clinical outcomes were extracted from the HIE registry and HIE follow up forms. RESULTS: The proportion of newborn infants who survived was 68/81(84%), (95%: CI: 0.74, 0.91). The factors associated with survival were a Thompson score of 7 to10 at initiation of the therapeutic Hypothermia (HR: 0.07, 95% CI: 0.01, 0.94) and at 24 hours of cooling (HR: 0.03, 95%CI: 0.004, 0.21), being born within the hospital providing therapeutic hypothermia (HR: 0.26, 95% CI: 0.07, 0.94) and not needing mechanical ventilator (HR: 0.03, 95% CI: 0.01, 0.14) or inotropic support. (HR: 0.13, 95%CI: 0.04, 0.38). The median time to attainment of full cup feeds was 6 days, with the majority 43/68(63%) attaining full feeds from 5 to 8 days. The median time to discharge was 7 days, and the median time to death was 3 days. The median Thompson score at discharge was 1 and at death was 16 CONCLUSION: The survival rate of the infants treated with therapeutic Hypothermia in our setting at 84% is comparably high. Rolling out therapeutic hypothermia in resource limited settings is recommended under strict protocols.