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Don't cool me, I'll cool you

The neonatal world feels pretty smug about cooling therapy for hypoxic-ischaemic encephalopathy. This previously intractable condition is now routinely treated; it has a relatively small number-needed-to-treat, so a relatively good chance of success for each baby treated; and cooling is well tolerated and largely free of harm. How irritating if it turns out that nature got there first. Dulip Jayasinghe (Neonatology 2015;107:220–3) suggests that hypothermia, mediated by reduced heat production, might actually be an innate and indeed adaptive response of babies to perinatal asphyxia. His review brings together several lines of evidence to suggest that in this case, our medical arts imitate life. And we should not be irritated: it's good to be working with physiology rather than against it.

But is it cool to be hungry?

Some neonatal services feed their babies during cooling, but other don't, mostly for fear of the consequences of possible gut ischaemia. Which should we do? Thyagarajan et al (Acta Paediatrica 2015;104:146–51) have done a neat little comparison of an English cohort, not fed during cooling, with a Swedish cohort, fed from a median of just under 24 hours. So …

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