title: Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial.
abstract: BACKGROUND
  This is a phase 4 study of infants registered with the UK TOBY Cooling Register from December 2006 to February 2008. The registry was established on completion of enrolLment to the TOBY randomised trial of treatment with whole body hypothermia following perinatal asphyxia at the end of November 2006.
  
  
  METHODS
  We collected information about patient characteristics, condition at birth, resuscitation details, severity of encephalopathy, hourly temperature record, clinical complications and outcomes before hospital discharge.
  
  
  RESULTS
  120 infants born at a median of 40 (IQR 38-41) weeks' gestation and weighing a median of 3287 (IQR 2895-3710) g at birth were studied. Cooling was started at a median of 3 h 54 min (IQR 2 h-5 h 32 min) after birth. All but three infants underwent whole body cooling. The mean (SD) rectal temperature from 6 to 72 h of the cooling period was 33.57 degrees C (0.51 degrees C). The daily encephalopathy score fell: median (IQR) 11 (6-15), 9.7 (5-14), 8 (5-13) and 7 (2-12) on days 1-4 after birth, respectively. 51% of the infants established full oral feeding at a median (range) of 9 (4-24) days. 26% of the study infants died. MRI was consistent with hypoxia-ischaemia in most cases. Clinical complications were not considered to be due to hypothermia.
  
  
  CONCLUSIONS
  In the UK, therapeutic hypothermia following perinatal asphyxia is increasingly being provided. The target body temperature is successfully achieved and the clinical complications observed were not attributed to hypothermia. Treatment with hypothermia may have prevented the worsening of the encephalopathy that is commonly observed following asphyxia.
authors.affiliation: Division of Clinical Sciences, Hammersmith Campus, Imperial College, London W12 0NN, UK. d.azzopardi@imperial.ac.uk
authors.forename: D
authors.initials: D
authors.lastname: Azzopardi
authors.forename: B
authors.initials: B
authors.lastname: Strohm
authors.forename: A D
authors.initials: AD
authors.lastname: Edwards
authors.forename: H
authors.initials: H
authors.lastname: Halliday
authors.forename: E
authors.initials: E
authors.lastname: Juszczak
authors.forename: M
authors.initials: M
authors.lastname: Levene
authors.forename: M
authors.initials: M
authors.lastname: Thoresen
authors.forename: A
authors.initials: A
authors.lastname: Whitelaw
authors.forename: P
authors.initials: P
authors.lastname: Brocklehurst
mesh_terms: D000367:Age Factors; D001238:Asphyxia Neonatorum / Q000150:complications / Q000628:therapy*; D001724:Birth Weight; D001831:Body Temperature; D017327:Clinical Trials, Phase IV as Topic; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000706:statistics & numerical data*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D011364:Professional Practice / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012007:Rectum / Q000503:physiopathology; D012042:Registries; D012720:Severity of Illness Index; D006113:United Kingdom