Whole Body Cooling in Newborn Infants with Perinatal Asphyxial Encephalopathy in a Low Resource Setting: A Feasibility Trial.

ABSTRACT

Objective: To determine the feasibility and safety of whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting. Design: Feasibility trial. Setting: Tertiary care perinatal centre. Subjects: Infants born at  35 weeks gestation with perinatal asphyxia were included in the study. Interventions: Infants were cooled to a rectal temperature of 33±0.5°C for 72 hours using cloth-covered ice-gel packs. Vital parameters were monitored continuously. Outcome measures: The primary outcome was the achievement of target temperature within 1 hour of initiation of treatment and maintaining the target temperature for 72 hours. Adverse events and possible complications of hypothermia were the secondary outcomes measured. Results: Twenty infants were included in the study. The mean time taken to achieve target rectal temperature was 52±25 minutes. The mean rectal temperature during cooling was 32.9±0.11ºC. The target temperature could be maintained for 72 hours without difficulty in all babies. Adverse events observed during cooling were thrombocytopenia (25%), sinus bradycardia (25%), deranged bleeding parameters (20%), aposteatonecrosis (15%), hyperglycemia (15%), hypoglycemia (10%), hypoxemia (5%), life-threatening coagulopathy (5%) and death (5%). Shivering was noted in many of the babies, especially in the initial phase of cooling. Conclusion: Whole body cooling in term infants with perinatal asphyxia is achievable, safe and inexpensive in a low-resource setting.