Acute Kidney Injury after Hypoxic Ischemic Encephalopathy in Neonates Treated with Passive Versus Active Total Body Cooling

Hypoxic-ischemic encephalopathy (HIE) affects 1-2 per 1000 term live births, often resulting in severe long-term disabilities. Therapeutic hypothermia (TH) is the standard care in developed countries, but high costs of modern cooling devices necessitate low-cost alternatives. This study compares passive cooling with active machine cooling regarding short-term renal outcomes, specifically acute kidney injury (AKI), in neonates with HIE. This retrospective study was conducted at Dr. Soliman Fakeeh Hospital's neonatal intensive care unit from 2019 to 2023. The study analyzed patient demographics, clinical outcomes, and laboratory data (sodium, potassium, urea, and creatinine) to assess AKI. Treatment involved whole-body cooling at 33.5-34.5°C for 72 hours, followed by gradual rewarming. A total of 39 neonates were included in the study. Both cooling methods showed similar short-term renal outcomes, with no statistically significant differences in creatinine levels between the groups at baseline, 24 hours, 72 hours, or discharge. A trend of higher creatinine levels in the passive cooling group was observed, but it did not reach statistical significance. The median length of hospital stay was longer in the passive cooling group, though this difference was marginally nonsignificant. Long-term follow-up revealed no significant differences in chronic kidney disease incidence or neurodevelopmental outcomes between the groups. This study found no significant differences in both short-term renal outcomes and long-term effects between passive and active cooling methods in neonates with HIE. However, the trend of higher creatinine levels in the passive cooling group suggests the need for further investigation with larger sample sizes and extended follow-up to clarify the long-term effects of cooling methods on renal and neurodevelopmental outcomes in neonates with HIE.