title: Therapeutic hypothermia can be induced and maintained using either commercial water bottles or a "phase changing material" mattress in a newborn piglet model.
abstract: BACKGROUND
  Therapeutic hypothermia, a safe and effective treatment for neonatal encephalopathy in an intensive care setting, is not available in low-resource settings. Aims/
  
  
  METHODS
  To assess two low-tech, low-cost cooling devices for use in low-resource settings: (i) commercially available water bottles filled with tepid water (25 degrees C); (ii) a mattress made of phase changing material (PCM) with a melting point of 32 degrees C (PCM works as a heat buffer at this temperature). Eleven anaesthetised newborn piglets were studied following transient hypoxia-ischaemia. The cooling device was applied 2-26 h after hypoxia-ischaemia with a target rectal temperature (T(rectal)) of 33-34 degrees C. T(rectal) undershoot was adjusted using cotton blankets; the cooling device was renewed when T(rectal) rose above 35 degrees C. T(rectal) data during cooling were dichotomised (within or without target) to assess: (a) the total period within the target T(rectal) range; (b) the stability and fluctuation of T(rectal) during cooling.
  
  
  RESULTS
  Therapeutic hypothermia was achieved with both water bottles (n = 5) and the PCM mattress (n = 6). The mean (SD) time to reach target T(rectal) was 1.8 (0.5) h with water bottles and 1.9 (0.3) h with PCM. PCM cooling led to a longer period within the target T(rectal) range (p<0.01) and more stable cooling (p<0.05). Water bottle cooling required device renewal (in four out of five piglets).
  
  
  CONCLUSIONS
  Simple, low-tech cooling devices can induce and maintain therapeutic hypothermia effectively in a porcine model of neonatal encephalopathy, although frequent fine tuning by adjusting the number of blankets insulating the piglet was required to maintain a stable temperature. PCM may induce more stable cooling compared with water bottles.
authors.affiliation: Academic Neonatology, EGA UCL Institute for Women's Health, University College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Iwata
authors.forename: O
authors.initials: O
authors.lastname: Iwata
authors.forename: L
authors.initials: L
authors.lastname: Olson
authors.forename: A
authors.initials: A
authors.lastname: Kapetanakis
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.forename: Y
authors.initials: Y
authors.lastname: Araki
authors.forename: T
authors.initials: T
authors.lastname: Kakuma
authors.forename: T
authors.initials: T
authors.lastname: Matsuishi
authors.forename: F
authors.initials: F
authors.lastname: Setterwall
authors.forename: H
authors.initials: H
authors.lastname: Lagercrantz
authors.forename: N J
authors.initials: NJ
authors.lastname: Robertson
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001831:Body Temperature / Q000502:physiology*; D001927:Brain Diseases / Q000628:therapy; D004867:Equipment Design; D007036:Hypothermia, Induced / Q000295:instrumentation*; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D008297:Male; D023421:Models, Animal; D011897:Random Allocation; D013552:Swine; D013696:Temperature