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To cool or not to cool? Hypothermia treatment outside trial criteria
  1. Topun Austin1,
  2. Shanthi Shanmugalingam2,
  3. Paul Clarke3
  1. 1Neonatal Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Neonatal Unit, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
  3. 3Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  1. Correspondence to Dr Topun Austin,Neonatal Unit, Box 226, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; topun.austin{at}


Most infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy fit the clinical criteria used in the main randomised controlled trials. Many infants who would not strictly have qualified for trial entry may nevertheless benefit from hypothermia. These may include infants presenting with postnatal collapse, infants with neonatal stroke and moderately preterm infants. Given the relative safety and potential lifelong benefits of hypothermia treatment, all patients who may benefit from cooling should receive it in a timely and consistent manner. This article reviews several clinical scenarios where cooling may be considered for neuroprotection and provides practical management guidance based on available evidence. The authors emphasise the importance of clear communication with parents and of maintaining national registers to record practices.

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