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Turk J Med Sci
Turk J Med Sci
Turkish Journal of Medical Sciences
1300-0144
1303-6165
Scientific and Technological Research Council of Turkey (TUBITAK)

10.55730/1300-0144.5859
tjmed-54-04-876
Letter to the Editor
Targeted temperature management in obstetrics for the prevention of perinatal encephalopathy
https://orcid.org/0000-0002-9829-9463
URAKOV Aleksandr 1*
https://orcid.org/0000-0002-4233-9550
URAKOVA Natalya 2
1 Department of General and Clinical Pharmacology, Faculty of Medicine, Izhevsk State Medical University, Izhevsk, Russia
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Izhevsk State Medical University, Izhevsk, Russia
* Correspondence: urakoval@live.ru
2024
21 7 2024
54 4 876877
03 2 2024
23 8 2024
21 7 2024
© TÜBİTAK
2024
https://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License.
Hypoxic-ischemic encephalopathy
therapeutic hypothermia
targeted temperature management
stillbirth
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pmcTo the Editor,

We read the article titled “Neurodevelopmental evaluation of newborns who underwent hypothermia with a diagnosis of hypoxic ischemic encephalopathy based on the Bayley-III scale,” written by Deveci et al. and published in Turkish Journal of Medical Sciences, with great interest [1]. We appreciated this work and would like to note what fruitful efforts the authors made while writing the article. The use of therapeutic hypothermia in obstetrics and gynecology is increasing every year as hypoxic-ischemic brain cell damage remains an important factor in stillbirth and neonatal encephalopathy in all countries of the world. To date, however, there is nothing more effective than therapeutic hypothermia. We agree that one significant factor in the efficacy of therapeutic hypothermia for neonatal health is its early application [1]. However, we would like to note that the aforementioned article does not consider the body temperatures of pregnant women. The temperature of the fetal head is completely dependent on the body temperature of the mother. Therefore, the intensity of aerobic metabolism and the oxygen demand of the fetal brain directly depend on the maternal body temperature [2–4]. One important factor of maternal body temperature is the time of day, as there are diurnal rhythms of body temperature [5]. Accordingly, the body temperature of the mother and fetus may be about 36.1 °C in the early morning and about 37.2 °C in the evening.

In other words, maternal and fetal temperatures can differ by 1.1 °C between morning and evening. According to the Arrhenius law, an increase in temperature by 10 °C increases the rate of chemical reactions by two times (i.e., by 100%), and so an increase in fetal body temperature by 1 °C increases the intensity of metabolism by an average of 10%. Therefore, the same reserve of fetal adaptation to hypoxia may have other significance for preserving the health and life of the neonate during vaginal delivery in cases of different body temperatures of the mother and the fetus. It is most likely that such a difference in temperature would occur in vaginal deliveries in the early morning and evening [2]. Based on this, we believe that the temperature of the mother and fetus in vaginal delivery at different times of the day is an important factor in neonatal encephalopathy. It is very important to use early therapeutic hypothermia not only for the newborn but also for the fetus [6]. However, the latter is not possible without lowering the temperature of the woman in labor. There are currently limited treatment methods for obtaining the “right” temperature, the most advanced of which is targeted temperature management (TTM) [7,8]. Temperature prophylaxis of hypoxic-ischemic brain injury is still being modernized, and it is necessary to adjust our approaches to the use of TTM in order to improve the efficiency and safety of birth and prevent not only perinatal encephalopathy but also stillbirth.

Not applicable.

Conflict of interest: The authors declare that there are no potential conflicts of interest.
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References

1 Deveci MF Güven Baysal Şenay Alagöz M Gökçe İK Gümüş Doğan D Neurodevelopmental evaluation of newborns who underwent hypothermia with a diagnosis of hypoxic ischemic encephalopathy based on the Bayley-III scale Turkish Journal of Medical Sciences 2023 53 6 1786 1793 10.55730/1300-0144.5748 38813516
2 Urakova N Urakov A Sokolova V Shabanov P Aerobic brain metabolism, body temperature, oxygen, fetal oxygen supply and fetal movement dynamics as factors in stillbirth and neonatal encephalopathy: invention review Azerbaijan Pharmaceutical and Pharmacotherapy Journal 2023 22 2 105 112 10.61336/appj/22-2-24
3 Shabanov P Samorodov A Urakova N Fisher E Shchemeleva A Low fetal resistance to hypoxia as a cause of stillbirth and neonatal encephalopathy Clinical and Experimental Obstetrics and Gynecology 2024 51 2 33 10.31083/j.ceog5102033
4 Urakov A Urakova N Fetal hypoxia: temperature value for oxygen exchange, resistance to hypoxic damage, and diagnostics using a thermal imager Indian Journal of Obstetrics and Gynecology Research 2020 7 2 232 238 10.18231/j.ijogr.2020.048
5 Melanie E Kittrell W Satinoff E Diurnal rhythms of body temperature, drinking and activity over reproductive cycles Physiology and Behavior 1988 42 5 477 484 10.1016/0031-9384(88)90180-1 3393610
6 Jackson TC Kochanek PM A new vision for therapeutic hypothermia in the era of targeted temperature management: a speculative synthesis Therapeutic Hypothermia and Temperature Management 2019 9 1 13 47 10.1089/ther.2019.0001 30802174
7 Lunze K Bloom DE Jamison DT Hamer DH The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival BMC Medicine 2013 11 24 10.1186/1741-7015-11-24 23369256
8 Beykmirza R Mehrabani ER Hashemi M Shahri MM Negarandeh R Development, implementation, and evaluation of neonatal thermoregulation decision support web application BMC Medical Informatics and Decision Making 2023 23 1 227 10.1186/s12911-023-02302-4 37853355
