Logical Decision Rules to Assign Neuroprotective Hypothermia Treatment to Infants with Hypoxic Ischemic Encephalopathy
Perinatal asphyxia (PA) is the aggression produced to the fetus or newborn around the time of delivery due to lack of oxygen or decreased tissue perfusion, producing hypoxemia, hypercapnia and metabolic acidosis. The central nervous system is most affected due to the high glucose consumption of nervous cells. By decreasing the amount of available energy substrates, several brain damage pathways are activated, resulting in cell death, leading to hypoxic-ischemic encephalopathy. In Uruguay the hypoxic-ischemic encephalopathy is the third mortality cause among newborns. In addition, many of those who survive suffer from severe neurological sequelae. In recent years a novel therapeutic alternative has been developed by lowering body temperature by 3 to 4 degrees Celsius. This should be done following strict protocols of patient selection, cooling, maintenance and reheating of newborns. Using Logic and flow charts, we formalized the patient selection criteria for the Therapeutic Protocol with Controlled Hypothermia. This will allow such clinical management to be included into information structures as decision support systems, optimizing the results and the use of resources of health services.