Journal
SEMINARS IN FETAL & NEONATAL MEDICINE
Volume 20, Issue 2, Pages 72-79Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.siny.2014.10.004
Keywords
Therapeutic hypothermia; Low- and middle-income countries; Neonatal encephalopathy; Neonatal mortality
Categories
Funding
- Bill and Melinda Gates foundation (HELIX trial) [OPP1069985]
- Biomedical Research Centre, Imperial [P51286]
- Bill and Melinda Gates Foundation [OPP1069985] Funding Source: Bill and Melinda Gates Foundation
- National Institutes of Health Research (NIHR) [HCS DRF-2014-05-013] Funding Source: National Institutes of Health Research (NIHR)
- National Institute for Health Research [NIHR/CS/010/022, HCS DRF-2014-05-013] Funding Source: researchfish
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Although cooling therapy has been the standard of care for neonatal encephalopathy (NE) in high-income countries for more than half a decade, it is still not widely used in low- and middle-income countries (LMIC), which bear 99% of the encephalopathy burden; neither is it listed as a priority research area in global health. Here we explore the major roadblocks that prevent the use of cooling in LMIC, including differences in population comorbidities, suboptimal intensive care, and the lack of affordable servo-controlled cooling devices. The emerging data from LMIC suggest that the incidence of coexisting perinatal infections in NE is no different to that in high-income countries, and that cooling can be effectively provided without tertiary intensive care and ventilatory support; however, the data on safety and efficacy of cooling are limited. Without adequately powered clinical trials, the creeping and uncertain introduction of cooling therapy in LMIC will be plagued by residual safety concerns, and any therapeutic benefit will be even more difficult to translate into widespread clinical use. (C) 2014 Elsevier Ltd. All rights reserved.
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