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Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study

J. Dingley, J. Tooley, X. Liu, E. Scull-Brown, M. Elstad, E. Chakkarapani, H. Sabir, M. Thoresen, John Dingley

PEDIATRICS, Volume: 133, Issue: 5, Pages: 809 - 818

Swansea University Author: John Dingley

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DOI (Published version): 10.1542/peds.2013-0787

Abstract

BACKGROUND AND OBJECTIVES:Therapeutic hypothermia has become standard of care in newborns with moderate and severe neonatal encephalopathy; however, additional interventions are needed. In experimental models, breathing xenon gas during cooling offers long-term additive neuroprotection. This is the...

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Published in: PEDIATRICS
ISSN: 0031-4005 1098-4275
Published: 2014
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URI: https://cronfa.swan.ac.uk/Record/cronfa27457
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last_indexed 2018-06-30T04:06:32Z
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spelling 2018-06-29T19:47:30.7666242 v2 27457 2016-04-26 Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study 1283ffdd09b091ec57ec3e235a48cfcc John Dingley John Dingley true false 2016-04-26 MEDS BACKGROUND AND OBJECTIVES:Therapeutic hypothermia has become standard of care in newborns with moderate and severe neonatal encephalopathy; however, additional interventions are needed. In experimental models, breathing xenon gas during cooling offers long-term additive neuroprotection. This is the first xenon feasibility study in cooled infants. Xenon is expensive, requiring a closed-circuit delivery system.METHODS:Cooled newborns with neonatal encephalopathy were eligible for this single-arm, dose-escalation study if clinically stable, under 18 hours of age and requiring less than 35% oxygen. Xenon duration increased stepwise from 3 to 18 hours in 14 subjects; 1 received 25% xenon and 13 received 50%. Respiratory, cardiovascular, neurologic (ie, amplitude-integrated EEG, seizures), and inflammatory (C-reactive protein) effects were examined. The effects of starting or stopping xenon rapidly or slowly were studied. Three matched control subjects per xenon treated subject were selected from our cooling database. Follow-up was at 18 months using mental developmental and physical developmental indexes of the Bayley Scales of Infant Development II.RESULTS:No adverse respiratory or cardiovascular effects, including post-extubation stridor, were seen. Xenon increased sedation and suppressed seizures and background electroencephalographic activity. Seizures sometimes occurred during rapid weaning of xenon but not during slow weaning. C-reactive protein levels were similar between groups. Hourly xenon consumption was 0.52 L. Three died, and 7 of 11 survivors had mental and physical developmental index scores ≥70 at follow-up.CONCLUSIONS:Breathing 50% xenon for up to 18 hours with 72 hours of cooling was feasible, with no adverse effects seen with 18 months' follow-up. Journal Article PEDIATRICS 133 5 809 818 0031-4005 1098-4275 hypothermia; hypoxic-ischemic encephalopathy; neonatal encephalopathy; newborn; quality of life; sedation; ventilation; xenon 31 12 2014 2014-12-31 10.1542/peds.2013-0787 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2018-06-29T19:47:30.7666242 2016-04-26T22:32:11.0762587 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine J. Dingley 1 J. Tooley 2 X. Liu 3 E. Scull-Brown 4 M. Elstad 5 E. Chakkarapani 6 H. Sabir 7 M. Thoresen 8 John Dingley 9
title Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
spellingShingle Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
John Dingley
title_short Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
title_full Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
title_fullStr Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
title_full_unstemmed Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
title_sort Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study
author_id_str_mv 1283ffdd09b091ec57ec3e235a48cfcc
author_id_fullname_str_mv 1283ffdd09b091ec57ec3e235a48cfcc_***_John Dingley
author John Dingley
author2 J. Dingley
J. Tooley
X. Liu
E. Scull-Brown
M. Elstad
E. Chakkarapani
H. Sabir
M. Thoresen
John Dingley
format Journal article
container_title PEDIATRICS
container_volume 133
container_issue 5
container_start_page 809
publishDate 2014
institution Swansea University
issn 0031-4005
1098-4275
doi_str_mv 10.1542/peds.2013-0787
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description BACKGROUND AND OBJECTIVES:Therapeutic hypothermia has become standard of care in newborns with moderate and severe neonatal encephalopathy; however, additional interventions are needed. In experimental models, breathing xenon gas during cooling offers long-term additive neuroprotection. This is the first xenon feasibility study in cooled infants. Xenon is expensive, requiring a closed-circuit delivery system.METHODS:Cooled newborns with neonatal encephalopathy were eligible for this single-arm, dose-escalation study if clinically stable, under 18 hours of age and requiring less than 35% oxygen. Xenon duration increased stepwise from 3 to 18 hours in 14 subjects; 1 received 25% xenon and 13 received 50%. Respiratory, cardiovascular, neurologic (ie, amplitude-integrated EEG, seizures), and inflammatory (C-reactive protein) effects were examined. The effects of starting or stopping xenon rapidly or slowly were studied. Three matched control subjects per xenon treated subject were selected from our cooling database. Follow-up was at 18 months using mental developmental and physical developmental indexes of the Bayley Scales of Infant Development II.RESULTS:No adverse respiratory or cardiovascular effects, including post-extubation stridor, were seen. Xenon increased sedation and suppressed seizures and background electroencephalographic activity. Seizures sometimes occurred during rapid weaning of xenon but not during slow weaning. C-reactive protein levels were similar between groups. Hourly xenon consumption was 0.52 L. Three died, and 7 of 11 survivors had mental and physical developmental index scores ≥70 at follow-up.CONCLUSIONS:Breathing 50% xenon for up to 18 hours with 72 hours of cooling was feasible, with no adverse effects seen with 18 months' follow-up.
published_date 2014-12-31T12:57:13Z
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