Dealing with the sequelae of cardiac arrest or asphyxia in a previously normal adult or child is always very difficult, for the pediatrician as much as the family. We now know that following resuscitation there can be a “latent” phase with transient recovery of cerebral energy metabolism, before a secondary phase of deterioration as determined by seizures, cytotoxic edema, and cerebral energy failure.,3  This latent phase may persist as long as 6 to 15 hours after reperfusion in infants. It is highly likely that the processes active during this latent period involve activation of the intracytoplasmic phase of programmed cell death.,5 

There is now strong experimental evidence that changes in postischemic cerebral temperature initiated during the latent phase can critically modulate these processes. As reviewed elsewhere, whereas brief hypothermia immediately after resuscitation has limited and inconsistent results, extended periods of mild to moderate cerebral...

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