Article Text

Download PDFPDF
Implications of the HELIX trial for treating infants with hypoxic-ischaemic encephalopathy in low-to-middle-income countries
  1. Joanne O Davidson1,
  2. Malcolm R Battin2,
  3. Alistair J Gunn1
  1. 1 Department of Physiology, The University of Auckland, Auckland, New Zealand
  2. 2 Department of Neonatology, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Prof Alistair J Gunn, Department of Physiology, The University of Auckland, Auckland 1023, New Zealand; aj.gunn{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Perinatal hypoxia-ischaemia (HI) is the single most common trigger of perinatal brain injury, and contributes to over 2 million deaths worldwide each year, of which about 96% were from low/middle-income countries (LMICs).1 2 In high-income countries (HICs), there is compelling evidence that therapeutic hypothermia for infants with HI encephalopathy (HIE) reduces grey and white matter lesions3 4 and improves survival without disability.5–7 In view of the differing populations, risks and medical systems, it cannot be assumed that even such a simple and low-cost treatment would be suitable for LMICs.8 Supporting this concern, the HELIX Study, a large, well-designed and executed randomised controlled trial of therapeutic hypothermia for HIE in LMICs, found that treatment did not reduce the combined outcome of death or disability at 18 months of age and increased mortality.9 The authors concluded that therapeutic hypothermia should not be offered to infants with neonatal encephalopathy in LMICs, even when tertiary-level neonatal intensive care support is available. The study raises two important questions: (1) why therapeutic hypothermia was not beneficial in this setting despite a high level of neonatal care and (2) how to reduce the burden of injury for affected infants in the future. We propose that better targeting of treatment may enable benefit even in this setting.

It is important to appreciate that some findings of the CoolCap Study, carried out in multiple HICs, were surprisingly consistent with HELIX. Secondary analysis of CoolCap suggested that not all …

View Full Text


  • Contributors This commentary was conceived by AJG. JOD wrote the first draft, JOD, MB and AJG revised the manuscript for content and approved the final version of the paper.

  • Funding The authors are supported by funding from the Health Research Council of New Zealand (grant numbers 17/601, 20/030).

  • Competing interests None declared.

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

Linked Articles

  • Highlights from this issue
    Ben J Stenson