Comparison between selective head cooling and whole-body cooling in neonatal therapeutic hypothermia

Main Article Content

Guilherme Rangel e Souza
Letícia de Oliveira Zambeli
Vinícius Parma Ruela
Anna Carolina Bovarêto Silveira
Maria Eduarda Dias Maia
Geandra Martins de Freitas
Julia Machado Vieira
Vitor Fernandes Alvim


Introduction: Experimental evidence, as well as improved clinical studies of the reduction of brain injury and, improves the neurological outcome, in newborns with hypoxic-ischemic encephalopathy (HIE) occurring in therapeutic hypothermia (TH). Objective: To verify the potential of hypothermic hypoxic-ischemic encephalopathy (HIE) therapy in neonatal asphyxia, based on literature data, comparing the benefits between selective head cooling (SHC) and whole-body cooling (WBC), see that the use of TH as a standard treatment in newborns with moderate or severe HIE has been adopted. Methods: A search was performed in the PubMed and SciELO databases of human studies, using the keywords “Therapeutic Hypothermia”, “Induced Hypothermia”, and “Hypoxic-Ischemic Encephalopathy”, “Selective cooling of the head”, “Total body cooling” and its variables. Results: Eleven articles were selected to compose the review, after detailed reading. There is a consensus, that the reduction of the risk of death or disability at 18 months of life in neonates with moderate to severe HIE, occurs to TH through the techniques of WBC or SHC. It was found in the studies that there is no difference in terms of adverse effects between the two methods. As for radiological changes, such as hypoxic-ischemic injuries and the incidence of seizures after cooling, they are more frequent with SHC. Conclusion: Both WBC and SHC demonstrated neuroprotective properties, although WBC provides a broader area of brain protection. However, no significant differences were found between the methods in terms of adverse effects and beneficial short or long-term results.


Download data is not yet available.

Article Details

How to Cite
Souza, G. R. e, Zambeli, L. de O., Ruela, V. P., Silveira, A. C. B., Maia, M. E. D., Freitas, G. M. de, Vieira, J. M., & Alvim, V. F. (2022). Comparison between selective head cooling and whole-body cooling in neonatal therapeutic hypothermia. ABCS Health Sciences, 48, e023301.
Review Articles


Elbahtiti A, Aly NY, Abo-Lila R, Al-Sawan R. Therapeutic hypothermia for infants with hypoxic ischemic encephalopathy: A five years’ single center experience in Kuwait. J Neonatal Perinatal Med. 2016;19;9(2):179-85.

- Nonato M, Gheler L, Balestrieri JV, Audi M, Prandini M. Selective head cooling and whole body cooling as neuroprotective agents in severe perinatal asphyxia. Rev Assoc Med Bras. 2019;65(8):1116-21.

Long M, Brandon DH. Induced hypothermia for neonates with hypoxic-ischemic encephalopathy. J Obstetr Gynecol Neonatal Nurs. 2007;36:293-8.

Shankaran S, Laptook AR, Ehrenkranzn RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic–ischemic encephalopathy. N Engl J Med. 2005;353(15):1574-84.

Gulczynska EM, Gadzinowski J, Kesiak M, Sobolewska B, Caputa J, Maczko A. Therapeutic hypothermia in asphyxiated newborns: selective head cooling vs. whole body cooling - comparison of short term outcomes. Ginekol Pol. 2019;90(7):403-10.

Iwata O, Nabetani M, Takenouchi T, Iwaibara T, Iwata S, Tamura M. Hypothermia for neonatal encephalopathy: Nationwide Survey of Clinical Practice in Japan as of August 2010. Acta Paediatr. 2012;101:e197-202.

Gunn AJ, Battin M, Gluckman PD, Gunn TR, Bennet L. Therapeutic hypothermia: from lab to NICU. J Perinat Med. 2005;33(4):340-6.

Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thoresen M, et al. The TOBY Study Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr. 2008;8:17.

Sarkar S, Donn SM, Bapuraj JR, Bhagat I, Barks JD. Distribution and severity of hypoxic-ischaemic lesions on brain MRI following therapeutic cooling: selective head versus whole body cooling. Arch Dis Child Fetal Neonatal Ed. 2012;97:F335-9.

Atici A, Çelik Y, Gülaşı S, Turhan AH, Okuyaz Ç. Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: short term results. Turk Pediatri Ars. 2015;50(1):27-36.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9.

Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Obstet Gynecol. 2014;123(4):896-901.

Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365(9460):663-70.

Schulzke SM, Rao S, Patole SK. A systematic review of cooling for neuroprotection in neonates with hypoxic ischemic encephalopathy - are we there yet? BMC Pediatr. 2007;5;7:30.

Sarkar S, Barks JD, Bhagat I, Dechert R, Donn SM. Pulmonary dysfunction and therapeutic hypothermia in asphyxiated newborns: whole body versus selective head cooling. Am J Perinatol. 2009;26(4):265-70.

Silveira RC, Procianoy RS. Hypothermia therapy for newborns with hypoxic ischemic encephalopathy. J Pediatr (Rio J). 2015;91(6 Suppl 1):S78-83.

Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361(14):1349-58.

Sarkar S, Barks JD, Bhagat I, Donn SM. Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: whole-body cooling versus selective head cooling. J Perinatol. 2009;29(8):558-63.

Peliowski-Davidovich A, Canadian Paediatric Society, Fetus and Newborn Committee. Hypothermia for newborns with hypoxic ischemic encephalopathy. Paediatr Child Health. 2012;17(1):41-6.

Allen KA. Moderate hypothermia: is selective head cooling or whole body cooling better? Adv Neonatal Care. 2014;14(2):113-8.

Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012;166(6):558-66.

Guillet R, Edwards AD, Thoresen M, Ferriero DM, Gluckman PD, Whitelaw A, et al. Seven- to eight-year follow-up of the CoolCap trial of head cooling for neonatal encephalopathy. Pediatr Res. 2012;71(2):205-9.

Azzopardi D, Strohm B, Marlow N, Brocklehurst P, Deierl A, Eddama O, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med. 2014;371(2):140-9.