@article{Oliveira:2018:10.1136/bmjpo-2017-000245,
author = {Oliveira, V and Kumutha, JR E N and Somanna, J and Benkappa, N and Bandya, P and Chandrasekeran, M and Swamy, R and Mondkar, J and Dewang, K and Manerkar, S and Sundaram, M and Chinathambi, K and Bharadwaj, S and Bhat, V and Madhava, V and Nair, M and Lally, PJ and Montaldo, P and Atreja, G and Mendoza, J and Bassett, P and Ramji, S and Shankaran, S and Thayyil, S},
doi = {10.1136/bmjpo-2017-000245},
journal = {BMJ Paediatrics Open},
title = {Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device},
url = {http://dx.doi.org/10.1136/bmjpo-2017-000245},
volume = {2},
year = {2018}
}

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TY  - JOUR
AB  - 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. Clinical trial registration number: NCT01760629.
AU  - Oliveira,V
AU  - Kumutha,JR E N
AU  - Somanna,J
AU  - Benkappa,N
AU  - Bandya,P
AU  - Chandrasekeran,M
AU  - Swamy,R
AU  - Mondkar,J
AU  - Dewang,K
AU  - Manerkar,S
AU  - Sundaram,M
AU  - Chinathambi,K
AU  - Bharadwaj,S
AU  - Bhat,V
AU  - Madhava,V
AU  - Nair,M
AU  - Lally,PJ
AU  - Montaldo,P
AU  - Atreja,G
AU  - Mendoza,J
AU  - Bassett,P
AU  - Ramji,S
AU  - Shankaran,S
AU  - Thayyil,S
DO  - 10.1136/bmjpo-2017-000245
PY  - 2018///
SN  - 2399-9772
TI  - Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device
T2  - BMJ Paediatrics Open
UR  - http://dx.doi.org/10.1136/bmjpo-2017-000245
UR  - https://www.ncbi.nlm.nih.gov/pubmed/29637198
UR  - http://hdl.handle.net/10044/1/58607
VL  - 2
ER  - 

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