Necessity of early and continuous monitoring for possible infectious complications in children undergoing therapeutic hypothermia

• Published in: Acta Paediatrica Vol. 110; no. 3; pp. 805 - 810
• Main Authors: Brandt, Jennifer B., Steiner, Sabine, Schlager, Gerald, Sadeghi, Kambis, Vargha, Regina, Golej, Johann, Hermon, Michael
• Format: Journal Article
• Language: English
• Published: Norway Wiley Subscription Services, Inc 01.03.2021; John Wiley and Sons Inc
• Subjects: Case-Control Studies; Child; Children; Cold Temperature; continuous monitoring; Cytokines; C‐reactive protein; Humans; Hypothermia; Hypothermia, Induced - adverse effects; Immunodeficiency; Immunomodulation; Immunosuppressive agents; Infant; Infant, Newborn; Infants; infectious complications; Intensive Care Units, Pediatric; non‐invasive cooling; Regular; Regular & Brief Reports; Retrospective Studies; therapeutic hypothermia; continuous monitoring; C-reactive protein; non-invasive cooling; therapeutic hypothermia; infectious complications
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/apa.15506

Aim Since therapeutic hypothermia (TH) is known for its inhibitory effects on leucocyte migration and cytokine synthesis, our aim was to underline the necessity of early monitoring for potential immunomodulatory risks. Methods Using a 13‐year retrospective case‐control study at the paediatric intensive care unit (PICU) of the Medical University in Vienna, all newborn infants and children receiving TH were screened and compared with a diagnosis‐matched control group undergoing conventional normothermic treatment (NT). TH was accomplished by using a non‐invasive cooling device. Target temperature was 32‐34°C. Children with evident infections, a medical history of an immunodeficiency or undergoing immunosuppressive therapy, were excluded. Results During the observational period, 108 patients were screened, 27 of which underwent TH. Culture‐proven infections occurred in 22% of the TH group compared with 4% of the normothermic controls (P = .1). From the second day following PICU admission, median C‐reactive protein (CRP) values were higher in the TH group (day two P = .002, day three P = .0002, day six P = .008). Conclusion Children undergoing TH showed earlier and higher increases in CRP levels when compared to normothermic controls. These data underline the necessity of early and continuous monitoring for possible infectious complications.