Biochemical Derangements in Patients with Hypoxic Ischemic Encephalopathy Treated With Therapeutic Hypothermia
Bibliographic record
Abstract
Abstract BACKGROUND: Therapeutic hypothermia is the standard of care for treating moderate or severe hypoxic ischemic encephalopathy (HIE) due to birth asphyxia. During the cooling period, altered intermediary metabolism coupled with multi-organ injury due to the underlying hypoxia may result in significant metabolic and biochemical derangements. Since the introduction of therapeutic hypothermia we have noticed an apparent increase in hyperglycemia and hyponatremia though such has not been formally documented. OBJECTIVES: This study sought to determine if there is a difference in the incidence of biochemical derangements in patients undergoing therapeutic hypothermia for moderate to severe HIE compared to a historical control group receiving standard supportive care. DESIGN/METHODS: A retrospective chart review was performed with a cluster sampling technique to select all patients ≥35 weeks PMA with a primary admission diagnosis of HIE in the years 2006, 2009, and 2012 at a single institution. This covered a time period before therapeutic hypothermia was established as standard of care, when it was in its implementation phase, and once fully established. Other than the hypothermia itself, there were no major changes in management of these patients, particularly, no change in fluid management regimens. Gestational age, birth weight, APGARs, severity of HIE, medications, blood glucose, electrolytes, liver and renal function were collected retrospectively at all time points during the 72 hour cooling window. Analysis was performed using unpaired students ttest using 0.05 as a definition of statistical significance. RESULTS: 155 patients were identified, 20 were excluded due to gestational age or suspected/confirmed underlying genetic disorder leaving n=60 cooled neonates and n=75 uncooled. The average gestational age in the cooled group was 39 and 3/7 weeks and in the uncooled group it was 38 and 5/7 weeks. In both groups, there were slightly more males than females with 57% (n=34) in the cooled group and 59% (n=44) in the uncooled group. There is a statistically significant increase in plasma glucose in the cooled group on day one (7.37±1.73 vs. 5.49±1.89, P<0.01) and day two (6.26±1.61 vs 5.34±1.79, P <0.05). There was no difference on day three. Serum sodium was lower in the cooled group on all three days, though it was only statistically significant on day 1 (130.29±4.84 vs. 132.27±4.58, P<0.05). CONCLUSION: Our results suggest that without significant changes in fluid management, therapeutic hypothermia is associated with an increased incidence of hyperglycemia and hyponatremia. Further work is needed to determine if these derangements significantly affect short or long-term outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".