Unveiling the hidden risks: therapeutic creep in mild hypoxic ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) in neonates, particularly near-term and term infants, presents significant risks to survival and neurodevelopmental outcomes. Mild HIE, comprising about 50% of HIE cases, has traditionally been seen as lower risk compared to moderate and severe HIE. However, emerging research suggests that mild HIE can lead to similar adverse outcomes to more severe cases, including brain injury and neurodevelopmental impairment. Therapeutic hypothermia (TH), a proven intervention for moderate to severe HIE, has been largely excluded for mild HIE management due to a lack of robust evidence. This gap has led to a phenomenon known as therapeutic creep, where interventions like TH are extended to milder cases without solid guidelines, raising concerns about its appropriateness and efficacy. This short article discusses the possible limitations of this approach and highlights why evidence from new research is urgently required.