TY - JOUR T1 - Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device JF - BMJ Paediatrics Open DO - 10.1136/bmjpo-2017-000245 VL - 2 IS - 1 SP - e000245 AU - Vânia Oliveira AU - Jaya Raman Kumutha AU - Narayanan E AU - Jagadish Somanna AU - Naveen Benkappa AU - Prathik Bandya AU - Manigandan Chandrasekeran AU - Ravi Swamy AU - Jayashree Mondkar AU - Kapil Dewang AU - Swati Manerkar AU - Mangalabharathi Sundaram AU - Kamalaratnam Chinathambi AU - Shruti Bharadwaj AU - Vishnu Bhat AU - Vijayakumar Madhava AU - Mohandas Nair AU - Peter James Lally AU - Paolo Montaldo AU - Gaurav Atreja AU - Josephine Mendoza AU - Paul Bassett AU - Siddarth Ramji AU - Seetha Shankaran AU - Sudhin Thayyil A2 - , Y1 - 2018/03/01 UR - http://bmjpaedsopen.bmj.com/content/2/1/e000245.abstract N2 - 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. ER -