@article {Oliveirae000245, author = {V{\^a}nia Oliveira and Jaya Raman Kumutha and Narayanan E and Jagadish Somanna and Naveen Benkappa and Prathik Bandya and Manigandan Chandrasekeran and Ravi Swamy and Jayashree Mondkar and Kapil Dewang and Swati Manerkar and Mangalabharathi Sundaram and Kamalaratnam Chinathambi and Shruti Bharadwaj and Vishnu Bhat and Vijayakumar Madhava and Mohandas Nair and Peter James Lally and Paolo Montaldo and Gaurav Atreja and Josephine Mendoza and Paul Bassett and Siddarth Ramji and Seetha Shankaran and Sudhin Thayyil}, editor = {, and , and Shankaran, Seetha and Atreja, Gaurav and Chandrasekaran, Mani and Herberg, Jethro and Lally, Peter J and Mendoza, Josephine and Montaldo, Paolo and Oliveira, V{\^a}nia and Swamy, Ravi and Thayyil, Sudhin and Bassett, Paul and Dey, Arjun Chandra and Dey, Sanjoy Kumer and Islam, Mohammed Tariqul and Jahan, Ismat and Mannan, Mohammed Abdul and Moni, Sadeka Chowdhury and Shabuj, Kamrul Hasan and Shahidullah, Mohammod and Islam, Mohammed Nazrul and Nahar, Mst Nazmun and Jain, Ashish and Ramji, Siddarth and Manerkar, Swati and Mondkar, Jayashree and Dewang, Kapil and Bhiskar, Swapnil and Chandramohan, Rema and Kamalaratnam, Chinnathambi and Kumaraswami, Kumutha and Mangalabharathi, Sundaram and E, Narayanan and Sebastian, Monica and Vadekepad, Padmesh and Benkappa, Naveen and Bandya, Prathik and Kantharajanna, Usha and Krishnappa, Sowmya and Somanna, Jagdish and Shivanna, Niranjan Hunsanhalli and Seeralar, Arasar and Prakash, Vinayagam and Babu, Mythilli and Sajjid, Mohamed and Sathyanathan, Babu Peter and Ravi, R and Bharadwaj, Shruthi and Bhatt, Vishnu and Madhavan, Vijaykumar and Nair, Mohandas and Chathurangika, Kalpani and Munasinghe, Sanjeewa and Shaman rajindrajith, Radika Karunaratne and Rodrigo, Ranmali and Sumanasena, Samanmali and Wanigasinghe, Jithangi and Ajit, Radhika and Kumar, Sobha and Nair, Ashwathy}, title = {Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device}, volume = {2}, number = {1}, elocation-id = {e000245}, year = {2018}, doi = {10.1136/bmjpo-2017-000245}, publisher = {BMJ Specialist Journals}, 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{\textdegree}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{\textemdash}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{\textdegree}C (0.2), rewarming rate was 0.34{\textdegree}C (0.16{\textdegree}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.}, URL = {https://bmjpaedsopen.bmj.com/content/2/1/e000245}, eprint = {https://bmjpaedsopen.bmj.com/content/2/1/e000245.full.pdf}, journal = {BMJ Paediatrics Open} }