Experience of Therapeutic Hypothermia for Asphyxiated Neonates in Tertiary Care Referral Center in South India

Background: Birth asphyxia contributes to more than 20% of the neonatal deaths in India. Therapeutic hypothermia has been accepted as the standard of care for moderate to severe hypoxic-ischemic encephalopathy in the west. In this study, we present our center experience in using therapeutic hypothermia for asphyxiated babies over a period of 3 years ( Jan 2016–Jan 2019) in Level III Neonatal Intensive Care Unit (NICU).

Objectives: This study focuses on the short- and long-term outcomes of therapeutic hypothermia in asphyxiated neonates with moderate to severe encephalopathy.

Methods: 92 Babies who met TOBY criteria were cooled to 33°C – 34⁰ C using Criticool {Servo controlled devise} within 6 hours of birth for 72 h, followed by rewarming at 0.5°C/h till 36.5⁰C after consent was obtained. Primary outcomes studied were Mortality, Seizures, Encephalopathy duration, Neurological examination at discharge, and neurological follow up. The secondary outcomes studied were number of AED at discharge, duration of mechanical ventilation, hospital cost, feeding patterns, duration of hospital stay, magnetic resonance imaging (MRI) and electroencephalogram (EEG) changes.

Results: Total of 92 babies received therapeutic hypothermia. Fifty six (61%) had moderate encephalopathy where as thirty six (39%) had severe encephalopathy prior to cooling. Mean hour of cooling from birth was 4.16 hours of life. 94% of babies with moderate encephalopathy and 80% of severe encephalopathy improved. 39% had severe HIE and Regional specific HIE changes on MRI. Adverse events noted were Coagulopathy (62%), Thrombocytopenia (51%), Hypotension (72%), PPHN (60%), and Mechanical ventilation (55%).

Conclusion: Therapeutic Hypothermia in term infants with perinatal asphyxia is achievable, feasible, safe and cost effective. Therapeutic hypothermia resulted in better survival and neuro developmental outcomes though there was no significant reduction in MRI and EEG abnormalities.