Abstract:The 2020 recommendations from the International Liaison Committee on Resuscitation are an improved version of the 2015 version. The algorithm and 15 procedures are unchanged from 2015, but there are six procedures with new or changed recommendations. One new recommendation is briefing/debriefing following neonatal resuscitation. Procedures with changed suggestions/recommendations are as follows: suctioning of non‐vigorous infants delivered through meconium‐stained amniotic fluid, sustained inflation of preterm… Show more
“…Firstly, the trial was being conducted in highly selected tertiary neonatal units in South Asia, with facilities for invasive ventilation, optimal cardiovascular support, clinical expertise, and 3 Tesla MRI by a team highly experienced in therapeutic hypothermia. Secondly, an expensive automated servo-controlled device was being used [2].…”
Section: The Helix Trialmentioning
confidence: 99%
“…Neonatal encephalopathy is the most common cause of death and serious brain injury in term infants affecting at least 1.2 million infants globally every year; over 96% occurs in lowand middle-income countries (LMICs) [1]. In the United Kingdom and most high-income countries, therapeutic hypothermia has been the standard therapy for neonatal encephalopathy since 2007 and is recommended by the International Liaison Committee on Resuscitation (ILCOR) guidelines [2]. Although there was compelling evidence why the safety and efficacy of cooling therapy from high-income countries could not be directly extrapolated to LMICs, it was widely introduced into the clinical practice in India and other lowresource settings without adequate evaluation [3,4].…”
In the past decade, therapeutic hypothermia using a variety of low-cost devices has been widely implemented in India and other low-and middle-income countries (LMIC) without adequate evidence of either safety or efficacy. The recently reported data from the world’s largest cooling trial (HELIX - hypothermia for encephalopathy in low- and middle-income countries) in LMIC provides definitive evidence of harm of cooling therapy with increase in mortality (number to harm 9) and lack of neuroprotection. Although the HELIX participating centers were highly selected tertiary neonatal intensive care units in South Asia with facilities for invasive ventilation, cardiovascular support, and 3 Tesla magnetic resonance imaging (MRI), and the trial used state-of-the-art automated servo-controlled cooling devices, a therapy that is harmful under such optimal conditions cannot be safe in low-resource settings that cannot even afford servo-controlled cooling devices.The HELIX trial has set a new benchmark for conducting high quality randomized controlled trials in terms of research governance, consent, ethics, follow-up rates, and involvement of parents. The standard care for neonatal encephalopathy in LMIC should remain normothermia, with close attention to prevention of hyperthermia. There is no role for therapeutic hypothermia in LMIC as the efficacy of hypothermia is dependent on the population, and not merely on the level of neonatal intensive care facilities. Future research should explore timings and origins of brain injury and prevention of brain injury in LMIC, with a strong emphasis on academic research capacity building and patient and public engagement.
“…Firstly, the trial was being conducted in highly selected tertiary neonatal units in South Asia, with facilities for invasive ventilation, optimal cardiovascular support, clinical expertise, and 3 Tesla MRI by a team highly experienced in therapeutic hypothermia. Secondly, an expensive automated servo-controlled device was being used [2].…”
Section: The Helix Trialmentioning
confidence: 99%
“…Neonatal encephalopathy is the most common cause of death and serious brain injury in term infants affecting at least 1.2 million infants globally every year; over 96% occurs in lowand middle-income countries (LMICs) [1]. In the United Kingdom and most high-income countries, therapeutic hypothermia has been the standard therapy for neonatal encephalopathy since 2007 and is recommended by the International Liaison Committee on Resuscitation (ILCOR) guidelines [2]. Although there was compelling evidence why the safety and efficacy of cooling therapy from high-income countries could not be directly extrapolated to LMICs, it was widely introduced into the clinical practice in India and other lowresource settings without adequate evaluation [3,4].…”
In the past decade, therapeutic hypothermia using a variety of low-cost devices has been widely implemented in India and other low-and middle-income countries (LMIC) without adequate evidence of either safety or efficacy. The recently reported data from the world’s largest cooling trial (HELIX - hypothermia for encephalopathy in low- and middle-income countries) in LMIC provides definitive evidence of harm of cooling therapy with increase in mortality (number to harm 9) and lack of neuroprotection. Although the HELIX participating centers were highly selected tertiary neonatal intensive care units in South Asia with facilities for invasive ventilation, cardiovascular support, and 3 Tesla magnetic resonance imaging (MRI), and the trial used state-of-the-art automated servo-controlled cooling devices, a therapy that is harmful under such optimal conditions cannot be safe in low-resource settings that cannot even afford servo-controlled cooling devices.The HELIX trial has set a new benchmark for conducting high quality randomized controlled trials in terms of research governance, consent, ethics, follow-up rates, and involvement of parents. The standard care for neonatal encephalopathy in LMIC should remain normothermia, with close attention to prevention of hyperthermia. There is no role for therapeutic hypothermia in LMIC as the efficacy of hypothermia is dependent on the population, and not merely on the level of neonatal intensive care facilities. Future research should explore timings and origins of brain injury and prevention of brain injury in LMIC, with a strong emphasis on academic research capacity building and patient and public engagement.
“…An international consensus on cardiopulmonary resuscitation and emergency cardiovascular science, with treatment recommendations for resuscitating newborn infants, was published in 2020. In this overview, Saugstad et al 5 summarise the recommendations from the International Liaison Committee on Resuscitation and provide additional observations on heart rate detection, cord clamping, oxygenation and thermal control.…”
Section: A Critical Review Of the 2020 Treatment Recommendations For Resuscitating Newborn Infantsmentioning
“…Obwohl in den 1950er-Jahren der überwiegende Teil der Bewohner von Blindenheimen durch unkontrollierte Sauerstoffgabe nach der Geburt erblindet war, führte dies nur zu einer Gabe unter Messung des Sauerstoffgehalts im Blut, nicht jedoch zu randomisierten Studien zu Wirkungen und Nebenwirkungen einer Sauerstofftherapie. So erkannte man erst 50 Jahre später, dass Sauerstoff nicht nur zu einer Verzögerung des Beginns der Spontanatmung führt [13]. Landesweite Analysen in Schweden lassen vermuten, dass die Gabe von 100 % Sauerstoff für nur 3 Minuten nach der Geburt das Risiko für kindliche Malignome, insbesondere Leukämien, 3-fach erhöht, somit weltweit etwa 15 % der kindlichen Leukämien auf einemeist überflüssige -Gabe von Sauerstoff unmittelbar nach Geburt zurückzuführen sind [14][15][16].…”
unclassified
“…Nicht nur für jede Studie ist dies ein großes Handicap. Der vorgeschlagene Zeitpunkt der kompletten Entwicklung des Kindes wäre eine präzise und nachvollziehbare Lösung [13] und wurde schon zur Version 2015 vorgeschlagen. Jetzt ist für einen Teilbereich eine neue Zeitschiene eingeführt worden, für die aber ebenfalls keine Evidenz vorgelegt werden kann.…”
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