Gugulabatembunamahlubi Tenjiwe Jabulile Kali1, Miriam Martinez-Biarge2, Jeanetta Van Zyl3, Johan Smith1, Mary Rutherford4. 1. Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Tygerberg Children's Hospital, Cape Town, South Africa. 2. Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Department of Paediatrics, Hammersmith Hospital, Imperial College, London, UK. 3. Tygerberg Children's Hospital, Cape Town, South Africa. 4. Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Department of Perinatal Imaging and Health, Division of Bioengineering and Imaging Sciences, Centre for Developing Brain, St Thomas' Hospital King's College, London, UK.
Abstract
AIM: Therapeutic hypothermia (TH), shown in developed countries to improve outcome in infants with hypoxic-ischaemic encephalopathy (HIE), was introduced into standard care at Tygerberg Children's Hospital in 2008. We aimed to describe the management and characteristics of infants treated with TH at this tertiary centre as well as the logistical challenges encountered. METHODS: Infants admitted for TH between 2008 and 2011 were included. They fulfilled TOBY study entry criteria and were cooled using a whole-body cooling system. A retrospective analysis of the cooling process and clinical findings was made using data collected during treatment. RESULTS: 100 infants with mild (32%), moderate (45%) and severe (23%) HIE were treated over 3 years. Mean time to admission was 4.87 (±1.63) hours, median time from delivery to target temperature was 7.5 h (range 2.5-15.5 h). Mean temperature on admission was 35.5°C (±1.5°C). Overall, rectal temperature was within target temperature for 82.8% of the time. Complications noted were clinically suspected/proven infection (45%), abnormal coagulation tests (48%), thrombocytopenia (34%), need for inotropic support (17%), hypoglycaemia (4%) and hyperglycaemia (10%). Rate of follow-up at 1 year among survivors was 57%. Infants not attending 1-year follow-up were more likely to have HIV-infected mothers, but there were no other demographic or clinical differences when compared with those who attended follow-up. CONCLUSIONS: Cooling is feasible in a resource-limited setting, within a strict protocol. With close monitoring, the known and common complications occur as frequently as in less resource-limited settings. Surrogate markers of later outcome need to be explored where follow-up is problematic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
AIM: Therapeutic hypothermia (TH), shown in developed countries to improve outcome in infants with hypoxic-ischaemic encephalopathy (HIE), was introduced into standard care at Tygerberg Children's Hospital in 2008. We aimed to describe the management and characteristics of infants treated with TH at this tertiary centre as well as the logistical challenges encountered. METHODS: Infants admitted for TH between 2008 and 2011 were included. They fulfilled TOBY study entry criteria and were cooled using a whole-body cooling system. A retrospective analysis of the cooling process and clinical findings was made using data collected during treatment. RESULTS: 100 infants with mild (32%), moderate (45%) and severe (23%) HIE were treated over 3 years. Mean time to admission was 4.87 (±1.63) hours, median time from delivery to target temperature was 7.5 h (range 2.5-15.5 h). Mean temperature on admission was 35.5°C (±1.5°C). Overall, rectal temperature was within target temperature for 82.8% of the time. Complications noted were clinically suspected/proven infection (45%), abnormal coagulation tests (48%), thrombocytopenia (34%), need for inotropic support (17%), hypoglycaemia (4%) and hyperglycaemia (10%). Rate of follow-up at 1 year among survivors was 57%. Infants not attending 1-year follow-up were more likely to have HIV-infected mothers, but there were no other demographic or clinical differences when compared with those who attended follow-up. CONCLUSIONS: Cooling is feasible in a resource-limited setting, within a strict protocol. With close monitoring, the known and common complications occur as frequently as in less resource-limited settings. Surrogate markers of later outcome need to be explored where follow-up is problematic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Cally J Tann; Kathryn A Martinello; Samantha Sadoo; Joy E Lawn; Anna C Seale; Maira Vega-Poblete; Neal J Russell; Carol J Baker; Linda Bartlett; Clare Cutland; Michael G Gravett; Margaret Ip; Kirsty Le Doare; Shabir A Madhi; Craig E Rubens; Samir K Saha; Stephanie Schrag; Ajoke Sobanjo-Ter Meulen; Johan Vekemans; Paul T Heath Journal: Clin Infect Dis Date: 2017-11-06 Impact factor: 9.079