Effect of Hypothermia on Serum Myelin Basic Protein and Tumor Necrosis Factor-α in Neonatal Hypoxic-Ischemic Encephalopathy.

Abstract

OBJECTIVE\n\u2003Multiple randomized controlled trials have shown that hypothermia is a safe and effective treatment for neonatal moderate or severe hypoxic-ischemic encephalopathy (HIE). The neuroprotective mechanisms of hypothermia need further study. The aim of this study was to investigate the effect of hypothermia on the serum levels of myelin basic protein (MBP) and tumor necrosis factor-α (TNF-α) as well as neurodevelopmental outcomes in neonatal HIE.\n\n\nSTUDY DESIGN\n\u2003Eighty-five neonates with moderate-to-severe HIE were divided into a hypothermia group (n\u2009=\u200949) and a control group (n\u2009=\u200936). Serum levels of MBP and TNF-α within 6\u2009hours after birth and after 3 days of treatment were determined by enzyme-linked immunosorbent assay, and neurodevelopmental outcome at the age of 12 to 15 months was assessed by using the Gesell development scale.\n\n\nRESULTS\n\u2003After 3 days of treatment, serum levels of MBP and TNF-α in the control group were not significantly different from levels before treatment (p\u2009>\u20090.05), and serum levels of MBP and TNF-α in the hypothermia group were significantly lower than levels before treatment (p\u2009<\u20090.05). Serum levels of MBP and TNF-α were significantly negatively correlated with developmental quotient (DQ; r\u2009=\u2009\u2009-\u20090.7945, p\u2009=\u20090.0000; r\u2009=\u2009\u2009-\u20090.7035, p\u2009=\u20090.0000, respectively). Serum levels of MBP and TNF-α in neurodevelopmentally impaired infants were significantly higher than those in infants with suspected neurodevelopmental impairment and those in neurodevelopmentally normal infants (both p\u2009<\u20090.01). The rate of reduction of neurodevelopmental impairment was higher among infants in the hypothermia group than among those in the control group (χ2\u2009=\u200916.3900, p\u2009<\u20090.05).\n\n\nCONCLUSION\n\u2003Hypothermia can reduce serum levels of MBP and TNF-α in neonates with HIE. Inhibiting the release of TNF-α may be one of the mechanisms by which hypothermia protects the myelin sheath.\n\n\nKEY POINTS\n· Hypothermia can reduce serum levels of MBP and TNF-α in neonatal HIE.. · Hypothermia improves neurodevelopmental outcomes and reduces the rate of neurodevelopmental impairment.. · Hypothermia is a feasible and effective treatment for neonates with moderate or severe HIE..