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Letter
Evidence that therapeutic hypothermia should be continued for 72 hours
  1. Joanne O Davidson1,
  2. Malcolm Battin2,
  3. Alistair J Gunn1
  1. 1 Department of Physiology, University of Auckland, Auckland, New Zealand
  2. 2 Newborn Services, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Dr Alistair J Gunn; aj.gunn{at}auckland.ac.nz

https://doi.org/10.1136/archdischild-2018-315844

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    There is compelling clinical evidence that 72 hours of therapeutic hypothermia for infants with moderate to severe hypoxic ischaemic encephalopathy (HIE) significantly improves outcomes.1 Of concern, a recent Australian survey of clinical practice reported that hypothermia was stopped before 72 hours in 31% of infants who met the recommended entry criteria.2 Although in many cases this was for palliative care, in others it was for an ‘adverse event’ (34%) or clinical improvement (6%). Given the exceptional safety record of therapeutic hypothermia in multiple trials,1 it is unclear whether the apparent adverse events were related to hypothermia. Moreover, many infants were cooled who did not meet the criteria for cooling, for example, for mild HIE. Among the infants …

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    Footnotes

    • Contributors JOD conceptualised this perspective with AJG, drafted the initial manuscript and prepared the figure. MB reviewed and revised the manuscript. AJG conceptualised this perspective with JOD, and critically reviewed and revised the manuscript. All authors contributed to the conception and drafting of the manuscript and approved the final version of the manuscript as submitted.

    • Funding This research was funded by the Health Research Council of New Zealand (17/601) and the Neurological Foundation (NF1715-PG).

    • Competing interests None declared.

    • Ethics approval Auckland Animal Ethics Committee.

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