Therapeutic hypothermia for neonatal hypoxic‐ischaemic encephalopathy had favourable outcomes at a referral hospital in a middle‐income country

Abstract

Most infants with HIE survived without major impairment. Previously described predictors of neurodevelopmental outcome were good surrogate markers in this population.

Neurodevelopmental Outcomes in Neonates with Mild Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

“…When data were analyzed after excluding these 3 infants, 11/27 (40.7%) showed evidence of injury on MRI (9 mild and 2 moderate/severe). Neurodevelopmental followup was available in 13…”

“…Our proportion of cooled neonates with mild encephalopathy ($15%) is similar to other recent reports of neonates with mild encephalopathy being treated with TH. [11][12][13] One reason for this drift is the increasing use and familiarity with its safety profile prompting clinicians to err on the side of caution and offer TH to neonates with borderline entry criteria. In fact, a recent report highlighted that some centers are treating neonates with mild encephalopathy but discontinuing cooling before completion of 72 hours of hypothermia; more than 50% of these neonates had injury on MRI and 20% had developmental delays including language delay.…”

“…11,12 Interestingly, a recent report of the use of TH in a resource-limited country suggested that neonates with mild HIE may benefit from cooling. 13 There is, however, a paucity of data regarding NDs of neonates with mild HIE treated with TH. In this retrospective study, we investigate the clinical course and NDs of a cohort of infants with mild NE who underwent TH at our institution, including comparison of NDs to a local cohort of control infants without NE.…”

Therapeutic hypothermia in middle‐income settings: where to now?

“…In this issue, Kali et al. describe the early outcomes of infants with hypoxic‐ischaemic encephalopathy (HIE) after the introduction of therapeutic hypothermia (TH) to their neonatal service in the Western Cape province of South Africa . Therapeutic whole‐body cooling to a core temperature of 33.5°C for 72 hours is standard of care in many high‐income countries (HICs) with evidence of increased disability‐free survival and improved cognitive outcomes at early school age.…”

“…One of the great strengths of the study by Kali et al. is that the outcomes that they report are from a ‘real‐life’ cohort from a middle‐income setting . In doing so, they have effectively highlighted many of the challenges faced in translating evidence and protocols from HIC studies to a mid‐resource setting, where important differences in population and care setting frequently exist.…”