Physiologic and Pharmacologic Effects of Therapeutic Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy

Therapeutic hypothermia is emerging as a promising intervention to improve the neurodevelopmental outcome of infants with moderate to severe hypoxic-ischemic encephalopathy at birth. Understanding the physiologic effects and pharmacologic consequences of hypothermia is integral to the safe management and optimum outcome of these patients. In this review, we will begin with an overview of the physiologic consequences of hypothermia therapy in neonates, including changes in vital signs and laboratory values and other potential adverse effects. We then review effects of lowered core temperature on drug metabolism, clearance, and response that may significantly impact drug efficacy and toxicity, thereby affecting patient outcome.