Introduction Neonatal hypoxic-ischaemic encephalopathy (HIE) is the most common cause of neurological deficit in near-term infants. It is estimated to affect 2–3 neonates per 1000 live births. Controlled hypothermia can improve neonatal outcomes. The therapy has been available within tertiary level Neonatal Units in NHS GGC subsequent to the seminal UK randomised controlled trial of it use.¹

Aims To identify all neonates who underwent ‘cooling’ within GG&C over a 3 year period and assess clinical outcome up to 24 months.

Methods Neonates treated with cooling were identified retrospectively from the TOBY register and unit neonatal data. Case records were audited for management and outcome data.

Results Of 42,000 live births delivered 29 neonates were identified as having received cooling, 26 were born within GG&C. The incidence of cooling steadily increased from 0.4/1000 in 2008 to 1/1000 in 2010. All neonates cooled were born ≥ 35 weeks. Four infants had recognised ‘cooling’ complications. Eight neonates died, all within the neonatal period. Of the surviving infants, five demonstrated severe disability and two moderate disability as classified by Shankran et al,² twelve had no disability at discharge from follow-up. Information was not available for two survivors.

Conclusion The incidence of therapeutic cooling increased through the study period. Use of this therapy will increase further following recent NICE guidelines (2010). Good clinical outcomes can be rescued but a significant number of infants have neurodevelopmental delay. Comprehensive, standardised follow-up of all cooled infants should be offered as a local standard of care.

References

1. Azzopardi D, Strohm B, Edwards A, Dyet L, Halliday H, Juszczak E, Kapellou O, Levene M, Marlow N, Porter E, Thoresen M, Whitelaw A, Brocklehurst P. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009; 361:1349–1358

2. Shankaran S, Laptook A, Wright LL, Ehrenkranz RA, Donovan EF, Fanaroff AA, et al. Whole-body hypothermia for neonatal encephalopathy: animal observations as a basis for a randomized, controlled pilot study in term infants. Pediatrics 2002;110(2 Pt 1):377–85