The Use of Therapeutic Hypothermia in Neonates with Perinatal Asphyxia at Charlotte Maxeke Johannesburg Academic Hospital: A Retrospective Review.

Abstract

Therapeutic hypothermia (TH) has become the standard of care to reduce neurological damage following perinatal asphyxia. Current recommendations call for implementation of a standard, evidence-based protocol for the provision of TH. This is particularly challenging in resource-limited settings. This is a retrospective, descriptive study to determine whether neonates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) are receiving TH according to the unit protocol in place. The study included all neonates with a birth weight greater than 1800 g admitted to the CMJAH neonatal unit from January 1, 2013, to June 30, 2017, before 24 hours of life. Neonates were assessed as to whether they met the criteria for TH according to the protocol, and reasons for not providing TH to those who qualified were investigated. The total number of neonates enrolled for the study was 485. Three hundred patients met the criteria for TH. 185/300 appropriately received TH. One hundred fifteen patients were not cooled, despite meeting TH criteria. Reasons for this included severe clinical conditions (73/115) and a lack of equipment (26/115). Of the remaining 185 patients who did not meet TH criteria, 21 patients inappropriately received TH. A total of 206 neonates received TH. TH at CMJAH is largely being practiced as per protocol. Still, more resources are needed, not only to optimize the number of patients who have access to this treatment modality but also in terms of imaging and support strategies.