Therapeutic Hypothermia and Its Role in Preserving Brain Volume in Term Neonates with Perinatal Asphyxia

Perinatal asphyxia is a leading cause of neonatal morbidity and mortality, often resulting in hypoxic-ischemic encephalopathy (HIE) with lasting neurodevelopmental impairments. Therapeutic hypothermia has been proposed as a treatment to mitigate brain damage, but its effects on specific brain structures remain under investigation. This study explores the relationship between cerebral volumetry, cortical thickness, and neurodevelopment in term neonates with perinatal asphyxia, with or without therapeutic hypothermia. A prospective cohort of term neonates with perinatal asphyxia was divided into two groups: one group exposed to therapeutic hypothermia and another group from a different institution that did not receive therapeutic hypothermia (non-exposed). Brain MRI data were analyzed using Infant-FreeSurfer and machine learning algorithms to quantify volumes of the basal ganglia, gray matter, white matter, cortical gyri, cerebellum, and cortical thickness. Neurodevelopment was assessed using the Bayley Scale III, focusing on motor, cognitive, and language domains, with additional genetic analyses of neurodevelopmental markers. Statistical comparisons adjusted for therapeutic hypothermia revealed significant differences in brain volumes. Hypothermia-treated infants demonstrated increased gray and white matter volumes and greater cortical thickness in specific regions, correlating with improved neurodevelopmental outcomes. These findings suggest that therapeutic hypothermia has a neuroprotective effect on specific brain structures, contributing to better cognitive and motor development. The study underscores the potential of therapeutic hypothermia as a critical intervention for perinatal asphyxia. It highlights the need for further research on its long-term benefits, incorporating advanced neuroimaging techniques and genetic insights to optimize outcomes.