2023年3月7日付で、小児急性脳症に対する脳低温療法のReviewがJournal of Clinical Medicine (IF, 4.964)に掲載されました。過去22年分の文献を整理し、本治療に関する最新の知見を網羅した内容になっています。私どものチームが改良を重ねてきた重篤な小児急性脳症に対する治療プロトコールを円滑に実施できる高度医療施設は国内外でも限られているのが実情です。しかし、この治療を世界標準の先端治療へ推し進めることで、いつの日か世界中の子ども達の命と未来を急性脳症という不治の病から守ってあげることが可能になるものと、私は信じています。

Website: https://www.mdpi.com/2077-0383/12/6/2095

PDF Version: https://www.mdpi.com/2077-0383/12/6/2095/pdf

Brain Hypothermia Therapy and Targeted Temperature Management for Acute Encephalopathy in Children: Status and Prospects

George Imataka  et al. J. Clin. Med. 2023, 12, 2095. https://doi.org/10.3390/jcm12062095

Abstract: In adult intensive care, brain hypothermia therapy (BHT) was reported to be effective in neuroprotection after resuscitation and cardiac arrest. By contrast, in neonatal intensive care, the pathophysiology of brain damage caused by hypoxic–ischemic encephalopathy (HIE) is attributed to circulatory disturbances resulting from ischemia/reperfusion, for which neonatal brain cryotherapy is used. The International Liaison Committee on Resuscitation, 2010, recommends cerebral cryotherapy for HIE associated with severe neonatal pseudoparenchyma death. The usefulness of BHT for neuroprotection in infants and children, especially in pediatric acute encephalopathy, is expected. Theoretically, BHT could be useful in basic medical science and animal experiments. However, there are limitations in clinical planning for treating pediatric acute encephalopathy. No international collaborative study has been conducted, and no clinical evidence exists for neuroprotection using BHT. In this review, we will discuss the pathogenesis of neuronal damage in hypoxic and hypoperfused brains; the history of BHT, its effects, and mechanisms of action; the success of BHT; cooling and monitoring methods of BHT; adverse reactions to BHT; literature on BHT. We will review the latest literature on targeted temperature management, which is used for maintaining and controlling body temperature in adults in intensive care. Finally, we will discuss the development of BHT and targeted temperature management as treatments for pediatric acute encephalopathy.