Therapeutic Hypothermia in Latvia

Background: Therapeutic hypothermia (TH) has now become a standard of care for term and near term infants with moderate to severe hypoxic- ischemic encephalopathy. The method is protective by inhibiting various pathophysiological events in the cascade of injury. It has recently been proven to be the only medical intervention which reduces brain damage and improves an infant`s chance of survival and reduced disability. Neonatal TH in Latvia was started in 2012 – in University Children’s Hospital using whole body hypothermia (Criticool) and Riga Maternity Hospital presenting selective head cooling (Cool Cap). Since 2016 whole body hypothermia (Thecoterm) is also available in Pauls Stradins Clinical University Hospital.

Objective: Provide the information about our experience and results using TH in Latvia during 2012-2016 in newborns with moderate and severe hypoxic- ischemic brain damage.

Methods: In retrospective research, a total of 107 newborns with moderate and severe HIE receiving therapeutic hypothermia in tree hospitals were included in our analysis.

Results: Mortality rate – 17,76 % (19/107) is comparable with other European studies. At age 1 year 48 patients underwent neurodevelopmental examination. 33 (68,75%) - have normal neurological development; 7 (14,58%) - spastic tetraparesis and seizures; 4 (8,33%) - hemiparesis; 3 (6,25%) - mild motor development retardation; 1 (2,08%) – isolate language delay

Conclusions: 69% of the children whose neurological development was examined at the age of 1 had an age-appropriate psychomotor development. For 40% of the treated patients an MRI scan showed no signs of hypoxic ischemic damage - a finding that has a high correlation with good psychomotor development. There is no data in Latvia on the neurological development of patients of hypoxic ischemic encephalopathy who have not received TH, since there is no unified dynamic follow-up of these children.