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Ethical and practical issues relating to the global use of therapeutic hypothermia for perinatal asphyxial encephalopathy
  1. D J Wilkinson1,2,
  2. S Thayyil3,
  3. N J Robertson3
  1. 1The Ethox Centre, Department of Public Health and Primary Health Care, University of Oxford, Oxford, UK
  2. 2Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
  3. 3Neonatology, Institute for Women's Health, University College London, London, UK
  1. Correspondence to Dr Dominic J Wilkinson, The Ethox Centre, Department of Public Health and Primary Health Care, The University of Oxford, Badenoch Building, Headington, Oxford OX3 7LF, UK; dominic.wilkinson{at}


In intensive care settings in the developed world, therapeutic hypothermia is established as a therapy for term infants with moderate to severe neonatal encephalopathy due to perinatal asphyxia. Several preclinical, pilot and clinical trials conducted in such settings over the last decade have demonstrated that this therapy is safe and effective. The greatest burden of birth asphyxia falls, however, in low- and middle-income countries; it is still unclear whether therapeutic hypothermia is safe and effective in this context. In this paper, the issues around treatments that may be proven safe and effective in the developed world and the caution needed in translating these into different settings and populations are explored. It is argued that there are strong scientific and ethical reasons supporting the conduct of rigorous, randomised controlled trials of therapeutic hypothermia in middle-income settings. There also needs to be substantial and sustainable improvements in all facets of antenatal care and in the basic level of newborn resuscitation in low income countries. This will reduce the burden of disease and allow health workers to determine rapidly which infants are most eligible for potential neuroprotection.

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  • Funding DW is supported by an Oxford Nuffield Medical fellowship, an Eric Burnard fellowship and a Royal Australasian College of Physicians Astra-Zeneca medical fellowship. ST is funded by the Comprehensive Biomedical Research Centre (CBRC), University College London. This work was undertaken in part at UCL/UCH who received a proportion of funding form the UK Department of Health's NIHR Biomedical Research Centre's funding scheme. The funders had no involvement in this work.

  • Competing interests None.

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