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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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