Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device

Abstract

Although therapeutic hypothermia (TH) is the standard of care for hypoxic ischaemic encephalopathy in high-income countries, the safety and efficacy of this therapy in low-income and middle-income countries (LMICs) is unknown. We aimed to describe the feasibility of TH using a low-cost servo-controlled cooling device and the short-term outcomes of the cooled babies in LMIC.DesignWe recruited babies with moderate or severe hypoxic ischaemic encephalopathy (aged <6 hours) admitted to public sector tertiary neonatal units in India over a 28-month period. We administered whole-body cooling (set core temperature 33.5°C) using a servo-controlled device for 72 hours, followed by passive rewarming. We collected the data on short-term neonatal outcomes prior to hospital discharge.ResultsEighty-two babies were included—61 (74%) had moderate and 21 (26%) had severe encephalopathy. Mean (SD) hypothermia cooling induction time was 1.7 hour (1.5) and the effective cooling time 95% (0.08). The mean (SD) hypothermia induction time was 1.7 hour (1.5 hour), core temperature during cooling was 33.4°C (0.2), rewarming rate was 0.34°C (0.16°C) per hour and the effective cooling time was 95% (8%). Twenty-five (51%) babies had gastric bleeds, 6 (12%) had pulmonary bleeds and 21 (27%) had meconium on delivery. Fifteen (18%) babies died before discharge from hospital. Heart rate more than 120 bpm during cooling (P=0.01) and gastric bleeds (P<0.001) were associated with neonatal mortality.ConclusionsThe low-cost servo-controlled cooling device maintained the core temperature well within the target range. Adequately powered clinical trials are required to establish the safety and efficacy of TH in LMICs.Clinical trial registration number NCT01760629.

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

“…19,[41][42][43] Schultheiss et al concluded that hypothermia could protect retina ganglion cells against ischemia and increase the ischemic tolerance time for optic cells. 41 Moreover, research evidences show that hypothermia has a neuroprotective role for patients suffering from subarachnoid hemorrhages, 44 encephalopathy, 10 and cerebral edema due to stroke, 45 which supports this study results.…”

“…3 Recently, among different modes of intervention, hypothermia has been recognized for improving the final outcome of the diseases. 10 Hypothermia was first introduced in cardiac patients after cardiopulmonary resuscitation (CPR) studies showed that hypothermia was very effective. 11,12 Researchers hypothesized that mild hypothermia after stroke could reduce the neurological damage and delay brain death.…”

Effects of hypothermia on lung inflammation in a rat model of meconium aspiration syndrome

“…Although the NICU applications improved, the overall prevalence of morbidity in children born with meconium stained amniotic fluid is still high 1,10 . This present study indicated for the first time the therapeutic effect of hypothermia on meconium induced lung injury in a newborn rat model.…”

“…In some series, meconium stained liquor has been still reported in 22% to 55% of infants with hypoxic-ischemic encephalopathy (HIE) 10 . Therapeutic hypothermia has widely recommended in the standard of care for neonates with HIE 11 .…”

Protecting the developing brain: empowering child neurologists to become more preventative

“…Worldwide, the impact of brain cooling has dramatically reduced incidence of hypoxic-ischaemic encephalopathy; whilst low-and middle-income countries lag in this, costeffective devices are now being introduced through collaborative projects between neonatologists and child neurologists. 4 Research should be clinically applicable. Commencing with a clinical challenge and working backwards to the underlying cause is essential.…”