Therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy should not be discontinued in low- and middle-income countries

Ballot, Daynia; Ramdin, Tanusha; Bandini, Rossella M.; Nakwa, Firdose; Velaphi, Sithembiso; Coetzee, M; Masemola, Khomotso; Káli, G; Horn, A; Pillay, Shakti; Rensburg, Janse van; Pepper, M.

doi:10.7196/samj.2021.v111i12.16180

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Los restantes pacientes, con sospecha de patología intrauterina de tipo inflamatorio o infeccioso, parecen verse menos favorecidos por el uso de la hipotermia. Esta experiencia parece ser similar a la de otros países de bajos y medios ingresos que continúan realizando HT para EHI moderada y severa con resultados favorables [20] .…”

Section: Discussionunclassified

Hipotermia terapéutica para tratamiento de encefalopatía hipóxico-isquémica del recién nacido asfixiado: Características clínicas, radiológicas y electrográficas de los neonatos atendidos en el Instituto Nacional Materno Perinatal

2022

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La encefalopatía hipóxico-isquémica (EHI) es el síndrome neurológico causado por la asfixia perinatal. La hipotermia terapéutica (HT) ha demostrado reducir la mortalidad y morbilidad asociadas a EHI. Se realizó un estudio descriptivo retrospectivo con 30 recién nacidos con EHI moderada y severa que recibieron HT en la Unidad de Cuidados Intensivos del Instituto Materno Perinatal desde setiembre de 2017 a noviembre de 2020. Nueve de los casos fueron severos (30 %). El tiempo promedio de ingreso a HT fue 3.4 horas de vida. No se registraron efectos adversos importantes atribuibles a HT. Todos los pacientes severos tuvieron crisis epilépticas, ecografías cerebrales de ingreso y resonancias con anormalidades. La mortalidad fue de 20.0 %, aunque fue significativamente menor en el grupo con EHI moderada. Se identificaron las características de presentación clínica, electrográfica y radiológica de los neonatos con EHI que recibieron hipotermia terapéutica, la cual se muestra como un procedimiento seguro y efectivo.

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Section: Discussionunclassified

Hipotermia terapéutica para tratamiento de encefalopatía hipóxico-isquémica del recién nacido asfixiado: Características clínicas, radiológicas y electrográficas de los neonatos atendidos en el Instituto Nacional Materno Perinatal

2022

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“…antenatal factors priming the fetal brain for serious neurological injury intrapartum, has been highlighted in the controversial HELIX trial, performed in lowto middle-income countries (LMICs), [30] and rebuttals to this trial. [31] In essence, the HELIX trial suggested that all LMICs should immediately suspend cooling in neonates owing to the reported absence of benefit and increased mortality in neonates who were cooled. This was in contrast to the experience of academic hospitals in SA that use therapeutic hypothermia to treat NE with suspected HIE and showed benefit, [31] in contrast to the HELIX trial -a major difference in outcome.…”

Section: Intrapartum V Antenatal Factors In Cp Causation In Low-resou...mentioning

confidence: 99%

“…[31] In essence, the HELIX trial suggested that all LMICs should immediately suspend cooling in neonates owing to the reported absence of benefit and increased mortality in neonates who were cooled. This was in contrast to the experience of academic hospitals in SA that use therapeutic hypothermia to treat NE with suspected HIE and showed benefit, [31] in contrast to the HELIX trial -a major difference in outcome. The differences could be related to how intrapartum hypoxia was defined.…”

Section: Intrapartum V Antenatal Factors In Cp Causation In Low-resou...mentioning

confidence: 99%

Cerebral palsy and its medicolegal implications in low- resource settings – the need to establish causality and revise criteria to implicate intrapartum hypoxia: A narrative review

Bhorat,

Buchmann,

Soma-Pillay

et al. 2023

S Afr Med J

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The objective of this study was to establish scientific causality and to devise criteria to implicate intrapartum hypoxia in cerebral palsy (CP) in low-resource settings, where there is potential for an increase in damaging medicolegal claims against obstetric caregivers, as is currently the situation in South Africa. For the purposes of this narrative review, an extensive literature search was performed, including any research articles, randomised controlled trials, observational studies, case reports or expert or consensus statements pertaining to CP in low-resource settings, medicolegal implications, causality, and criteria implicating intrapartum hypoxia. In terms of causation, there are differences between high-income countries (HICs) and low-resource settings. While intrapartum hypoxia accounts for 10 - 14% of CP in HICs, the figure is higher in low-resource settings (20 - 46%), indicating a need for improved intrapartum care. Criteria implicating intrapartum hypoxia presented for HICs may not apply to low-resource settings, as cord blood pH testing, neonatal brain magnetic resonance imaging (MRI) and placental histology are frequently not available, compounded by incomplete clinical notes and missing cardiotocography tracings. Revised criteria in an algorithm for low-resource settings to implicate intrapartum hypoxia in neonatal encephalopathy (NE)/ CP are presented. The algorithm relies first on specialist neurological assessment of the child, determination of the occurrence of neonatal encephalopathy (by documented or verbal accounts) and findings on childhood MRI, and second on evidence of antepartum and intrapartum contributors to the apparent hypoxia-related CP. The review explores differences between low-resource settings and HICs in trying to establish causation in NE/CP and presents a revised scientific approach to causality in the context of low-resource settings for reaching appropriate legal judgments.

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Impact of Passive Therapeutic Hypothermia for Neonatal Asphyxia in a Developing Country

Pereira,

Celini,

Sarri

et al. 2024

Indian J Pediatr

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Therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy should not be discontinued in low- and middle-income countries

Cited by 6 publications

References 10 publications

Hipotermia terapéutica para tratamiento de encefalopatía hipóxico-isquémica del recién nacido asfixiado: Características clínicas, radiológicas y electrográficas de los neonatos atendidos en el Instituto Nacional Materno Perinatal

Hipotermia terapéutica para tratamiento de encefalopatía hipóxico-isquémica del recién nacido asfixiado: Características clínicas, radiológicas y electrográficas de los neonatos atendidos en el Instituto Nacional Materno Perinatal

Cerebral palsy and its medicolegal implications in low- resource settings – the need to establish causality and revise criteria to implicate intrapartum hypoxia: A narrative review

Impact of Passive Therapeutic Hypothermia for Neonatal Asphyxia in a Developing Country

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