Management of perinatal asphyxia in low-income countries with no facility for therapeutic hypothermia

[Peter Odion Ubuane]

Hi everyone. What are the possible options for providing therapeutic hypothermia to newborns with moderate-to-severe hypoxic ischaemic encephalopathy? Any idea from other centres with no standard cooling devices?

[Stefan Johansson]

@Peter Odion Ubuane The cooling trial in Australia was done with a low-tech solution, they used regular cooling "gel packs". If I remember correctly from a lecture long ago, they sometimes also used a table fan bedside, if they had problems to reach the target temp.

I found this photo below and local trial info on the web here: https://www.bettersafercare.vic.gov.au/resources/clinical-guidance/maternity-and-newborn-clinical-network/therapeutic-hypothermia-for-hypoxic-ischaemic-encephalopathy-initiation-in-special-care-nurseries

The trial publication is available free in full-text here: https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107569

 

[Mohan]

I am practicing on an exclusive mother and child care hospital in a resource poor setting in Western Odisha India where we get a lot of babies with birth asphyxia. For the last 4 yrs we have been using  a low cost device called Mira Cradle which uses phase change material in a a polyurethane cradle. We have found it to be very effective in maintaining the requisite temperature for 72 hrs without use of electricity. This has resulted in favorable out comes especially in babies with moderate encephalopathy 

[PRAKASH KABBUR]

I agree with Dr. Mohan. We have started cooling in India in a resource poor set up. We were able to overcome many challenges with lots of training and infrastructure changes. The process is going smooth. There are cheaper options for cooling babies. 

[Mohan]

Kindly attached a photograph of baby on Mira Cradle in our hospital