Hipotermia en encefalopatía hipóxico-neonatal
Resumen
ANTECEDENTES: La encefalopatía hipóxico-isquémica es una causa importante de daño neurológico agudo en el recién nacido. La hipotermia, inducida durante las primeras horas de vida, es un tratamiento eficaz para reducir la mortalidad y la discapacidad mayor en los niños que superviven a una agresión hipóxico isquémica perinatal.
OBJETIVO: Describir las características de los pacientes con asfixia perinatal moderada a severa con protocolo de hipotermia terapéutica, la evolución del desarrollo psicomotor y las secuelas neurológicas.
PACIENTES Y MÉTODOS: Análisis descriptivo (noviembre 2011-marzo 2017), retrospectivo, de las hospitalizaciones urgentes de recién nacidos que recibieron hipotermia activa corporal total. Se recabaron los datos clínicos, tratamiento, pruebas complementarias, complicaciones y secuelas neurológicas.
RESULTADOS: Se reunieron 51 casos, de los que 30 sufrieron encefalopatía severa y 21 moderada, según la escala de García Alix. Los hallazgos de resonancia magnética craneal fueron compatibles con encefalopatía hipóxico isquémica leve (n = 9), moderada (n = 4) y severa (n = 19). En 14 pacientes no se registraron hallazgos de encefalopatía hipóxico-isquémica. Sucedieron 16 fallecimientos, 15 enseguida de la adecuación del esfuerzo terapéutico. En la actualidad permanecen en consulta externa 15 pacientes con secuelas neurológicas; 8 se dieron de alta por estar asintomáticos y 6 se perdieron en el seguimiento.
CONCLUSIONES: La terapia con hipotermia controlada parece segura y ha demostrado mejor evolución de los pacientes con encefalopatía hipóxico isquémica moderadasevera.
Citas
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