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Residual brain injury after early discontinuation of cooling therapy in mild neonatal encephalopathy
  1. Peter J Lally1,
  2. Paolo Montaldo1,
  3. Vânia Oliveira1,
  4. Ravi Shankar Swamy1,
  5. Aung Soe2,
  6. Seetha Shankaran3,
  7. Sudhin Thayyil1
  1. 1 Centre for Perinatal Neuroscience, Imperial College London, London, UK
  2. 2 Oliver Fisher Neonatal Unit, Medway Maritime Hospital, Kent, UK
  3. 3 Department of Neonatal Perinatal Medicine, Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Peter J Lally, Centre for Perinatal Neuroscience, Imperial College London, Level 5, Hammersmith House, Du Cane Road, London, W12 0HS, UK; p.lally{at}


We examined the brain injury and neurodevelopmental outcomes in a prospective cohort of 10 babies with mild encephalopathy who had early cessation of cooling therapy. All babies had MRI and spectroscopy within 2 weeks after birth and neurodevelopmental assessment at 2 years. Cooling was prematurely discontinued at a median age of 9 hours (IQR 5–13) due to rapid clinical improvement. Five (50%) had injury on MRI or spectroscopy, and two (20%) had an abnormal neurodevelopmental outcome at 2 years. Premature cessation of cooling therapy in babies with mild neonatal encephalopathy does not exclude residual brain injury and adverse long-term neurodevelopmental outcomes. This study refers to babies recruited into the MARBLE study (NCT01309711, pre-results stage).

  • encephalopathy
  • therapeutic hypothermia
  • newborn
  • magnetic resonance

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  • PJL and PM contributed equally.

  • Contributors The first two authors PL and PM contributed equally to this manuscript. ST conceived the idea for this study. PJL, PM, VO, RSS and ST facilitated MRI scanning, data acquisition and analysis. ST and PJL analysed the magnetic resonance imaging and spectroscopy data, respectively. PM conducted neurodevelopmental assessments. PM and PJL wrote the first manuscript draft. AS and SS contributed to data analysis and advised on important intellectual content. All authors contributed to the manuscript revision and approved the final version.

  • Funding PL and VO are funded by National Institute for Health Research (NIHR) doctoral fellowships, and PM is funded by a Medical Research Council doctoral fellowship. ST is funded by a Weston endowment chair at Imperial College London. This research was supported by the NIHR Biomedical Research Centre based at Imperial College Healthcare National Health Service (NHS) Trust and Imperial College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained from the parents/guardian.

  • Ethics approval North London Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. The contributors statement has been updated.

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