Who to cool? A case series on therapeutic hypothermia following perinatal asphyxia from a private hospital in Tanzania

Abstract

Background

Neonatal hypoxic-ischaemic encephalopathy (HIE), characterized by significant brain and multi-organ dysfunction, accounts for a substantial portion of neonatal mortality and morbidity among survivors. Therapeutic hypothermia (TH) has demonstrated promising efficacy in reducing both disability and mortality in affected neonates, but studies from low- and middle-income countries have reported variable outcomes. This case series presents the real-world experience of implementing therapeutic hypothermia in resource-limited settings.

Methods

Ten neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) who met the criteria for therapeutic hypothermia underwent whole-body cooling using gel packs with servo-controlled heating at a level 4 private tertiary care hospital in Dar es Salaam, Tanzania. Core body temperature was continuously monitored via a rectal probe and maintained between 33.5 °C and 34.5 °C.

Results

Temperatures were effectively maintained within the target range, with a mean of 33.5 ± 0.7 °C, and no adverse events were observed.

The overall mortality rate was 50 % (5/10). All neonates with severe HIE (5/5) died, whereas all those with moderate HIE (5/5) survived; two survivors exhibited no residual neurological deficits at one year of age. All neonates with a base excess (BE) greater than –20, a Thompson score ≥ 15 within the first six hours, and an abnormal middle cerebral artery resistive index did not survive.

Conclusion

TH implementation using gel packs and servo-control is feasible. Neonates with severe HIE require careful selection for TH, as cooling these neonates in a resource-constrained setting may increase the overall resource burden.