Experience of therapeutic hypothermia in neonates with perinatal asphyxia in a tertiary care center in North Karnataka, India

Abstract

Introduction: Perinatal asphyxia contributes to 20%–30% of the neonatal deaths in India. In developed countries, therapeutic hypothermia (TH) is the established standard of care in asphyxiated neonates. In this study, we present our center experience in using TH for asphyxiated neonates using servo-controlled cooling machine.Subjects and Methods: This study was conducted in Level IIB Neonatal Intensive Care Unit (NICU) of Shri B M Patil Medical College Hospital Vijayapur, Karnataka, over a period of 1 year including neonates admitted in NICU with perinatal asphyxia. Babies with perinatal asphyxia (TOBY criteria) were enrolled in the protocol group and control group. In the protocol group, babies were cooled to 33.5°C using servo-controlled cooling machine within 6 h of birth for 72 h, followed by rewarming at 0.5°C/h to 36.5°C. In the control group, babies received standard supportive care as per unit protocol. Babies were enrolled in this study after taking verbal and written consent from parents.Results: Among 210 neonates included in the study, 92 in the protocol group received TH, whereas 118 neonates were in the control group. 10 neonates died/discharge against medical advice in the Protocol group whereas 22 neonates died/discharge against medical advice in the Control group. 35% and 19% had normal neurological examination at discharge in the protocol and control group, respectively. No statistically significant differences were observed among complications associated with TH between protocol and control group except for bradycardia and thrombocytopenia.Conclusion: TH resulted in better survival and neurodevelopmental outcomes at 18 months of age in our study. Developing training programs and improving infrastructure including neonatal transport are necessary for successful implementation of TH.