N TH IN PRETERMS

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FITNESS

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Summary Bullet Points:

Acta Paediatrica (2025) - Spahic, Zoubovsky, Dietz
EBNEO Commentary on Therapeutic Hypothermia for Preterm Infants (33–35 Weeks GA)

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• Background on HIE and Therapeutic Hypothermia (TH):

  • Hypoxic-ischemic encephalopathy (HIE) causes major morbidity and mortality.

  • TH is proven effective in reducing these risks in term and late preterm infants (>36 weeks GA).

  • Limited evidence exists for TH effectiveness in infants born at 33–35 weeks GA.

• Key Study – Faix et al. RCT:

  • Multicenter randomized trial evaluating TH vs. normothermia in 33–35 week GA infants with moderate/severe HIE.

  • Result: TH did not reduce death or disability compared to normothermia in this group.

• Comparison to Previous Studies:

  • The ICE trial (35–42 weeks GA) showed benefits of TH in more mature infants.

  • Small retrospective studies suggested possible TH benefit for preterm infants, influencing AAP guidelines to recommend TH for ≥35 weeks GA.

  • However, some data show higher mortality for 34–35 week infants undergoing TH compared to term infants.

• Clinical Implications:

  • Infants at 35 weeks GA may resemble 33–34 week infants more than ≥36 week infants in outcomes.

  • Late preterm infants have immature skin barriers and greater surface area-to-weight ratio → higher vulnerability to cold stress and related risks with TH.

• Practice Considerations:

  • Growing use of TH in preterm HIE despite limited evidence.

  • Suggests involving informed consent and shared decision-making with caregivers when considering TH for <36 week GA infants.

  • Until guidelines are updated, clinicians may face medical-legal challenges if deviating from AAP recommendations.

• Future Directions:

  • Urgent need for further research with larger cohorts and stratification by gestational age.

  • Calls for cross-institutional collaboration to better define TH’s role in infants <37 weeks GA.

  • Aim to refine national and institutional guidelines based on emerging evidence.

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References:

1. Current TH use and effectiveness.

2. AAP recommendations based on earlier studies.

3. Faix et al. (2025) RCT outcomes.

4. Risks and cold stress in late preterm infants.

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