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ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 7-11

The effect of whole body cooling in asphyxiated neonates with resource limitation: Challenges and experience


1 Department of Pediatrics, Command Hospital, Pune, Maharashtra, India
2 Department of Pediatrics, Base Hospital, New Delhi, India
3 Department of Pediatrics, Command Hospital, Chandigarh, India
4 Department of Pediatrics, Command Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Rahul Sinha
Department of Pediatrics, Command Hospital, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_59_17

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Background: Whole-body cooling is now recommended for the treatment neonates with hypoxic-ischemic encephalopathy (HIE) if started within 6 h of birth and continued for 72 h has shown to reduce the mortality and morbidity (1–4). The literature search also mentions the therapeutic beneficial effect of whole-body cooling in moderate-to-severe birth asphyxia. We publish the effect of whole-body cooling in asphyxiated neonates with resource limitation. Materials and Methods: It was a prospective interventional study of newborns admitted for HIE from October 2014 to April 2016 in Neonatal Intensive Care Unit (NICU) of Military Hospital (Level 2). There were 1565 deliveries during this period and 65 neonates with perinatal asphyxia were admitted in the unit. They were divided into two group by computer generated number so that the selection bias was minimised. The inclusion and exclusion criteria were determined as per the predesigned proforma. According to inclusion criteria, thirty inborn cases were eligible for the study group. The other control group included thirty neonates who did not receive whole-body cooling and was given treatment as per standard protocol. The remaining five babies were not included in the study group as they had mild birth asphyxia. The ethical approval and written informed consent were taken before the intervention. Inclusion criteria - Neonates born beyond 36 weeks of gestation and weight more than 2000 Grams were included in the study. The other inclusion criteria were umbilical cord or a postnatal (in the 1st h of life) arterial blood gas pH of <7.0 or base deficit of more than or equal to 16 along with any two of the following: (1) Apgar score of <5 at 5 min; (2) positive pressure ventilation (PPV) initiated at birth and continued for at least 10 min; (3) risk factor (anyone) - intrapartum fetal distress, cord prolapse, placental abruption, and uterine rupture/dehiscence. Exclusion criteria - Neonates born before 36 weeks and reported after 6 h of birth were excluded from the study. Statistical Analysis: Statistical analysis was carried out by SPSS 17. The difference between the two groups was studied either by the nonparametric Mann–Whitney test for quantitative variables or by Chi-square test or Fisher's test for qualitative variables. Statistical difference was considered significant if P < 0.05. Results: The primary outcome was measured in terms of neurological examination at 18 months of age and secondary outcome was measured in terms of adverse outcome and complications. The detail clinical examination and Denver Development Screening test were used for the neurological and developmental assessment. The neurological outcome at discharge and at 18 months of age was better in neonates given whole-body cooling than in the control group. The normal neurological outcome at 18 months of age was 70% compared to control group of 43% with P= 0.02. Furthermore, the cognitive delay at 18 months of age was lesser than control group.


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