BMJ Paediatrics Open (Oct 2018)
Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device
- Vânia Oliveira,
- Jaya Raman Kumutha,
- Narayanan E,
- Jagadish Somanna,
- Naveen Benkappa,
- Prathik Bandya,
- Manigandan Chandrasekeran,
- Ravi Swamy,
- Jayashree Mondkar,
- Kapil Dewang,
- Swati Manerkar,
- Mangalabharathi Sundaram,
- Kamalaratnam Chinathambi,
- Shruti Bharadwaj,
- Vishnu Bhat,
- Vijayakumar Madhava,
- Mohandas Nair,
- Peter James Lally,
- Paolo Montaldo,
- Gaurav Atreja,
- Josephine Mendoza,
- Paul Bassett,
- Siddarth Ramji,
- Seetha Shankaran,
- Sudhin Thayyil,
- ,
- Jethro Herberg,
- Peter J Lally,
- Jithangi Wanigasinghe,
- Ashish Jain,
- Mani Chandrasekaran,
- Arjun Chandra Dey,
- Sanjoy Kumer Dey,
- Mohammed Tariqul Islam,
- Ismat Jahan,
- Mohammed Abdul Mannan,
- Sadeka Chowdhury Moni,
- Kamrul Hasan Shabuj,
- Mohammod Shahidullah,
- Mohammed Nazrul Islam,
- Mst Nazmun Nahar,
- Swapnil Bhiskar,
- Rema Chandramohan,
- Chinnathambi Kamalaratnam,
- Kumutha Kumaraswami,
- Sundaram Mangalabharathi,
- Monica Sebastian,
- Padmesh Vadekepad,
- Usha Kantharajanna,
- Sowmya Krishnappa,
- Jagdish Somanna,
- Niranjan Hunsanhalli Shivanna,
- Arasar Seeralar,
- Vinayagam Prakash,
- Mythilli Babu,
- Mohamed Sajjid,
- Babu Peter Sathyanathan,
- R Ravi,
- Shruthi Bharadwaj,
- Vishnu Bhatt,
- Vijaykumar Madhavan,
- Kalpani Chathurangika,
- Sanjeewa Munasinghe,
- Radika Karunaratne Shaman rajindrajith,
- Ranmali Rodrigo,
- Samanmali Sumanasena,
- Radhika Ajit,
- Sobha Kumar,
- Ashwathy Nair
Affiliations
- Vânia Oliveira
- 1 Centre for Perinatal Neuroscience, Imperial College London, London, UK
- Jaya Raman Kumutha
- 2 Neonatal Medicine, Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India
- Narayanan E
- 2 Neonatal Medicine, Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India
- Jagadish Somanna
- 3 Neonatal Medicine, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
- Naveen Benkappa
- 3 Neonatal Medicine, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
- Prathik Bandya
- 3 Neonatal Medicine, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
- Manigandan Chandrasekeran
- 4 Neonatal Medicine, Cloudnine Hospital, Chennai, Tamil Nadu, India
- Ravi Swamy
- 1 Centre for Perinatal Neuroscience, Imperial College London, London, UK
- Jayashree Mondkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
- Kapil Dewang
- 7 Neonatal Medicine, Lokmanya Tilak Municipal Hospital, Sion, Mumbai, India
- Swati Manerkar
- 7 Neonatal Medicine, Lokmanya Tilak Municipal Hospital, Sion, Mumbai, India
- Mangalabharathi Sundaram
- 2 Neonatal Medicine, Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India
- Kamalaratnam Chinathambi
- 2 Neonatal Medicine, Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India
- Shruti Bharadwaj
- 8 Neonatal Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
- Vishnu Bhat
- 8 Neonatal Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
- Vijayakumar Madhava
- 9 Neonatal Medicine, Calicut Medical College, Kozhikode, Kerala, India
- Mohandas Nair
- 8 Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
- Peter James Lally
- 1 Centre for Perinatal Neuroscience, Imperial College London, London, UK
- Paolo Montaldo
- Department of Pediatrics, Second University of Naples, Naples, Italy
- Gaurav Atreja
- locum consultant neonatologist, Imperial College Healthcare NHS Trust, London
- Josephine Mendoza
- 1 Centre for Perinatal Neuroscience, Imperial College London, London, UK
- Paul Bassett
- Statsconsultancy Ltd, Amersham, UK
- Siddarth Ramji
- Pediatrics, Maulana Azad Medical College, New Delhi, Delhi, India
- Seetha Shankaran
- 3 Pediatrics Neonatology, Wayne State University Childrens Hospital of MI, Detroit, Michigan, USA
- Sudhin Thayyil
- 1 Centre for Perinatal Neuroscience, Imperial College London, London, UK
- Department of Clinical Surgery, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
- Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
- Peter J Lally
- Jithangi Wanigasinghe
- 1 Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Ashish Jain
- Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
- Mani Chandrasekaran
- Arjun Chandra Dey
- Sanjoy Kumer Dey
- Mohammed Tariqul Islam
- Ismat Jahan
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka District, Bangladesh
- Mohammed Abdul Mannan
- Sadeka Chowdhury Moni
- Kamrul Hasan Shabuj
- Mohammod Shahidullah
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Mohammed Nazrul Islam
- Mst Nazmun Nahar
- Swapnil Bhiskar
- Rema Chandramohan
- Chinnathambi Kamalaratnam
- Kumutha Kumaraswami
- Sundaram Mangalabharathi
- Monica Sebastian
- Padmesh Vadekepad
- Usha Kantharajanna
- Sowmya Krishnappa
- Jagdish Somanna
- Niranjan Hunsanhalli Shivanna
- Arasar Seeralar
- Vinayagam Prakash
- Mythilli Babu
- Mohamed Sajjid
- Babu Peter Sathyanathan
- R Ravi
- Shruthi Bharadwaj
- Vishnu Bhatt
- Vijaykumar Madhavan
- Kalpani Chathurangika
- Sanjeewa Munasinghe
- Radika Karunaratne Shaman rajindrajith
- Ranmali Rodrigo
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Samanmali Sumanasena
- 4Ayathi National Centre for Children with Disabilities
- Radhika Ajit
- Sobha Kumar
- 5 Pediatrics, Trivandrum Medical College, Thiruvananthapuram, Kerala, India
- Ashwathy Nair
- DOI
- https://doi.org/10.1136/bmjpo-2017-000245
- Journal volume & issue
-
Vol. 2,
no. 1
Abstract
Design We recruited babies with moderate or severe hypoxic ischaemic encephalopathy (aged <6 hours) admitted to public sector tertiary neonatal units in India over a 28-month period. We administered whole-body cooling (set core temperature 33.5°C) using a servo-controlled device for 72 hours, followed by passive rewarming. We collected the data on short-term neonatal outcomes prior to hospital discharge.Results Eighty-two babies were included—61 (74%) had moderate and 21 (26%) had severe encephalopathy. Mean (SD) hypothermia cooling induction time was 1.7 hour (1.5) and the effective cooling time 95% (0.08). The mean (SD) hypothermia induction time was 1.7 hour (1.5 hour), core temperature during cooling was 33.4°C (0.2), rewarming rate was 0.34°C (0.16°C) per hour and the effective cooling time was 95% (8%). Twenty-five (51%) babies had gastric bleeds, 6 (12%) had pulmonary bleeds and 21 (27%) had meconium on delivery. Fifteen (18%) babies died before discharge from hospital. Heart rate more than 120 bpm during cooling (P=0.01) and gastric bleeds (P<0.001) were associated with neonatal mortality.Conclusions The low-cost servo-controlled cooling device maintained the core temperature well within the target range. Adequately powered clinical trials are required to establish the safety and efficacy of TH in LMICs.Clinical trial registration number NCT01760629.
