Efficacy of therapeutic hypothermia (TH) in encephalopathic infants with co-existent sepsis is unknown; we assessed the brain tissue injury using magnetic resonance (MR) biomarkers in a south Indian public sector neonatal unit.
Methods We randomly allocated 33 infants (≥36 weeks, ≥1800 g) with neonatal encephalopathy (NE) to TH (reduction of rectal temperature to 33.5°C for 72 h) or standard care within 6 h of birth. MR images were acquired between day 7 and 11 using a 1.5 Tesla Siemens Avanto MR scanner and scored by a single reader using a previously validated proforma.1
Results Baseline characteristics were similar in the cooled (n=17) and standard care (n=16) groups; six infants died before MR imaging.
A trend towards increased sepsis (19% vs 53%), higher background EEG abnormality on day 4 (29% vs 47%) was seen in cooled infants. The brain tissue injury scores in the basal ganglia (odds ratio (95%CI) 3.4 (0.5, 22)), white matter (WM) (0.5 (0.08, 2.6) and cortex (4.7 (0.7,30) were similar in the control and cooled infants. No difference was seen on tract based spatial statistics with cooling; fractional anisotropy values were similar over the anterior and posterior limbs of internal capsule.
Conclusions TH did not reduce the brain injury after NE in this population; this may be due to different population co-morbidities and/or higher incidence of perinatal sepsis than in high-income settings. Carefully controlled clinical trials are required before TH is routinely used in these settings.
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