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.