Effectiveness of reaching and maintaining therapeutic hypothermia target temperature using low‐cost devices in newborns with hypoxic–ischemic encephalopathy

Abstract

Therapeutic hypothermia (TH) using servo-controlled cooling devices has proved to be a safe and effective method to reduce mortality and sequelae in neonates with hypoxic-ischemic encephalopathy (HIE). However, such cooling devices can be expensive and have limited availability in low-and middle-income countries. To evaluate the feasibility and effectiveness of low-cost cooling devices (ice packs) to reach and maintain the target temperature in newborns with moderate or severe HIE. Descriptive retrospective cross-sectional study, including newborns with gestational age ≥35 weeks, weight ≥1800 g, with diagnosis of moderate or severe HIE, submitted to whole body hypothermia using ice packs for 72 hr. Data was obtained from medical records and databases. The thermal curves of each patient, time spent at the target temperature and rewarming time were evaluated. Complications directly related to therapeutic hypothermia, evolution, and early outcomes before hospital discharge were analyzed. Seventy-one newborns met the criteria for TH, and 61 completed the entire cooling period and were included in the final analysis. The average time to reach the target temperature was 1.50 ± 1.3 hr. The mean temperature during the cooling period was 33.5 C (±0.62). 82.32% of the measurements were within the target temperature range (from 33 to 34 C). The following adverse events were observed during TH: pulmonary hypertension 11.3%, arrhythmia 4.2%, and coagulopathy 26.7%. Whole body hypothermia using low-cost devices proved to be an effective method in the absence of availability of servo-controlled devices, representing a plausible option in restricted resource settings.

The Feasibility of Telemedicine in the Implementation and Management of Therapeutic Hypothermia for Infants with Neonatal Hypoxic-Ischemic Encephalopathy in a Resource-Limited Country

“…A study from Brazil using low-cost materials for cooling (ice packs) reported staying in the targeted range in 82.3% of the time. 18 Similarly, in a study from India, ice packs cooling maintained temperature within the range in 92.5% of measurements. 19…”

“…Patients were referred for consultation at a median (IQR) of 137 (35-165) minutes of life. A median (IQR) of 12 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) minutes elapsed between the call for a consultation and the consultant's response, and a median (IQR) of 30 (0-42) minutes elapsed between seeking the consultation and the initiation of cooling therapy. All the patients who completed TH were followed daily through telemedicine till discharge.…”

“…A study from Brazil using low-cost materials for cooling (ice packs) reported staying in the targeted range in 82.3% of the time. 18 Similarly, in a study from India, ice packs cooling maintained temperature within the range in 92.5% of measurements. 19 Implementing TH to reduce mortality and/or morbidity was emphasized in a couple of large clinical trials in highincome countries.…”

Avaliação da repercussão da hipotermia terapêutica passiva nos aspectos cardiopulmonares e neurológicos em pacientes com asfixia neonatal

“…A proporção de pacientes tratados com hipotermia terapêutica foi semelhante nos dois grupos (66% versus 65%), concluindo que a prevalência de hipertensão pulmonar não foi diferente entre os bebês que receberam hipotermia terapêutica (18) . O estudo brasileiro já citado anteriormente encontrou uma porcentagem semelhante de hipertensão pulmonar em relação ao nosso estudo (11,3% versus 11,1% em nosso estudo), caracterizada pelo uso de óxido nítrico (12) .…”

“…Um estudo recente realizado no Brasil incluiu 61 RN com EHI moderada e grave submetidos à hipotermia, usando pacotes de gelo para o resfriamento, e avaliou desfechos a curto prazo antes da alta; encontrou um tempo médio para atingir a temperatura alvo de 1,5 horas (±1,3); a temperatura durante o resfriamento ideal foi de 33,5 C, sendo que 82,32% das medições estavam dentro da faixa de normalidade da temperatura alvo; demonstrou, assim, que a hipotermia terapêutica utilizando dispositivos de baixo custo provou ser um método eficaz na ausência de disponibilidade de dispositivos servo-controlados (12) .…”