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Evidence from animal models of human perinatal asphyxia has demonstrated that starting moderate hypothermia within 6 hours after the hypoxic-ischaemic insult provides neuroprotection.1–3 One of the beneficial effects of moderate hypothermia is presumed to be a reduction of ‘secondary energy failure’ which starts 6–8 hours after resuscitation.1 4
Trials in (near-)term human infants confirmed the beneficial effects of cooling when started within 6 hours, and most guidelines strongly recommend starting therapeutic hypothermia as soon as possible after perinatal asphyxia and subsequent encephalopathy.5
In their paper in this journal Guillot et al suggest that starting therapeutic hypothermia before 3 hours was not associated with a difference in brain injury on MRI or a better neurodevelopmental outcome at 18 months.6 They based their conclusions on observations in 91 infants of whom 61 had moderate to severe hypoxic ischaemic encephalopathy (HIE) before therapeutic hypothermia was started.
The authors suggest that time to start cooling is not relevant, although in the conclusions of their paper they state that …
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