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

Wednesday, 9th of May 2018 Print

 

BMJ Paediatr Open. 2018 Mar 23;2(1):e000245. doi: 10.1136/bmjpo-2017-000245. eCollection 2018.

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

Oliveira V#1Kumutha JR#2E N2Somanna J3Benkappa N3Bandya P3Chandrasekeran M4Swamy R1,5,6Mondkar J7Dewang K7Manerkar S7Sundaram M2Chinathambi K2Bharadwaj S8Bhat V8Madhava V9Nair M9Lally PJ1Montaldo P1Atreja G5Mendoza J1Bassett P10Ramji S11Shankaran S12Thayyil S1.

Author information

1 Centre for Perinatal Neuroscience, Imperial College London, London, UK.

2 Neonatal Medicine, Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India.

3 Neonatal Medicine, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.

4 Neonatal Medicine, Cloudnine Hospital, Chennai, Tamil Nadu, India.

5 Neonatal Medicine, Imperial College Healthcare NHS Trust, London, UK.

6 Neonatal Medicine, Perinatal Trials Unit, Bangalore, India.

7 Neonatal Medicine, Lokmanya Tilak Municipal Hospital, Sion, Mumbai, India.

8 Neonatal Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India.

9 Neonatal Medicine, Calicut Medical College, Kozhikode, Kerala, India.

10 Medical Statistics, Stats Consultancy, London, UK.

11 Neonatal Medicine, Maulana Azad Medical College, New Delhi, Delhi, India.

12 Neonatal Medicine, Wayne State University, Detroit, Michigan, USA.

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.

DESIGN:

We 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.

RESULTS:

Eighty-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.

CONCLUSIONS:

The 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.

 

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