Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device. Issue 1 (23rd March 2018)

• Record Type: Journal Article
• Authors: Oliveira, Vânia; Kumutha, Jaya Raman; E, Narayanan; Somanna, Jagadish; Benkappa, Naveen; Bandya, Prathik; Chandrasekeran, Manigandan; Swamy, Ravi; Mondkar, Jayashree; Dewang, Kapil; Manerkar, Swati; Sundaram, Mangalabharathi; Chinathambi, Kamalaratnam; Bharadwaj, Shruti; Bhat, Vishnu; Madhava, Vijayakumar; Nair, Mohandas; Lally, Peter James; Montaldo, Paolo; Atreja, Gaurav; Mendoza, Josephine; Bassett, Paul; Ramji, Siddarth; Shankaran, Seetha; Thayyil, Sudhin
• Other Names: author non-byline.; Shankaran Seetha author non-byline.; Atreja Gaurav author non-byline.; Chandrasekaran Mani author non-byline.; Herberg Jethro author non-byline.; Lally Peter J author non-byline.; Mendoza Josephine author non-byline.; Montaldo Paolo author non-byline.; Oliveira Vânia author non-byline.; Swamy Ravi author non-byline.; Thayyil Sudhin author non-byline.; Bassett Paul author non-byline.; Dey Arjun Chandra author non-byline.; Dey Sanjoy Kumer author non-byline.; Islam Mohammed Tariqul author non-byline.; Jahan Ismat author non-byline.; Mannan Mohammed Abdul author non-byline.; Moni Sadeka Chowdhury author non-byline.; Shabuj Kamrul Hasan author non-byline.; Shahidullah Mohammod author non-byline.; Islam Mohammed Nazrul author non-byline.; Nahar Mst Nazmun author non-byline.; Jain Ashish author non-byline.; Ramji Siddarth author non-byline.; Manerkar Swati author non-byline.; Mondkar Jayashree author non-byline.; Dewang Kapil author non-byline.; Bhiskar Swapnil author non-byline.; Chandramohan Rema author non-byline.; Kamalaratnam Chinnathambi author non-byline.; Kumaraswami Kumutha author non-byline.; Mangalabharathi Sundaram author non-byline.; E Narayanan author non-byline.; Sebastian Monica author non-byline.; Vadekepad Padmesh author non-byline.; Benkappa Naveen author non-byline.; Bandya Prathik author non-byline.; Kantharajanna Usha author non-byline.; Krishnappa Sowmya author non-byline.; Somanna Jagdish author non-byline.; Shivanna Niranjan Hunsanhalli author non-byline.; Seeralar Arasar author non-byline.; Prakash Vinayagam author non-byline.; Babu Mythilli author non-byline.; Sajjid Mohamed author non-byline.; Sathyanathan Babu Peter author non-byline.; Ravi R author non-byline.; Bharadwaj Shruthi author non-byline.; Bhatt Vishnu author non-byline.; Madhavan Vijaykumar author non-byline.; Nair Mohandas author non-byline.; Chathurangika Kalpani author non-byline.; Munasinghe Sanjeewa author non-byline.; Shaman rajindrajith Radika Karunaratne author non-byline.; Rodrigo Ranmali author non-byline.; Sumanasena Samanmali author non-byline.; Wanigasinghe Jithangi author non-byline.; Ajit Radhika author non-byline.; Kumar Sobha author non-byline.; Nair Ashwathy author non-byline.;
• Is Part Of: BMJ paediatrics open. Volume 2:Issue 1(2018)
• Publication Date: 2018-03-23
• Subjects: neonatology -- encephalopathy -- hypothermia -- brain injury -- low and middle-income; Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.920005
• DOI: 10.1136/bmjpo-2017-000245
• Languages: English
• ISSNs: 2399-9772

Abstract

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. Clinical trial registration number: NCT01760629 .