Summary Background Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. Methods We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18–22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov , NCT02387385 . Findings We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87–1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. Interpretatio...

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Control of spasms at three months was significantly better if initially treated with prednisolone. Control of spasms at six and 12 months was not significantly different despite a trend favoring prednisolone. Risk of relapse following initial remission was similar in the two groups.

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Objective To correlate hospital attendance for wheezing treated with nebulizer therapy with pollutant levels recorded in ambient air in Colombo.Setting Emergency treatment unit (ETU) of the Lady Ridgeway Hospital, Colombo.Design A prospective observational case control study.Method Attendance at the ETU for nebulizer therapy was recorded daily for 12 months. ETU attendance for conditions other than wheezing served as controls. The case and control attendance rates were correlated with daily maximum and minimum one hour average levels of sulfur dioxide and oxides of nitrogen in ambient air as measured by the continuous pollution monitor situated in the Fort, Colombo.Results 30,932 children needed nebulizer therapy in the ETU (median daily attendance 85) during the period of 12 months. The control population was 10,100 children (median daily attendance 28). The pattern of pollutant levels and attendance rates for wheezing showed a correlation on a time series.Conclusion Air pollution levels in Colombo correlated significantly with hospital attendance rates for wheezing needing emergency treatment. The highest recorded levels of sulfur dioxide and oxides of nitrogen in ambient air showed a significant correlation with the highest hospital attendance rates, and the lowest pollutant levels with the lowest hospital attendance rates. We conclude that vehicle related pollutants in ambient air in Colombo are affecting the respiratory health of children. _________________________________________