Ethical and practical issues relating to the global use of therapeutic hypothermia for perinatal asphyxial encephalopathy

D J Wilkinson, S Thayyil, N J Robertson

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)F75-8
JournalArchives of Disease in Childhood. Fetal and Neonatal Edition
Volume96
Issue number1
DOIs
Publication statusPublished - Jan 2011

Keywords

  • Asphyxia Neonatorum/complications
  • Developing Countries
  • Developmental Disabilities/prevention & control
  • Ethics, Medical
  • Humans
  • Hypothermia, Induced/ethics
  • Hypoxia-Ischemia, Brain/etiology
  • Infant, Newborn
  • Perinatal Care/ethics
  • Translational Medical Research

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