title: Cooling in a low-resource environment: lost in translation.
abstract: Although cooling therapy has been the standard of care for neonatal encephalopathy (NE) in high-income countries for more than half a decade, it is still not widely used in low- and middle-income countries (LMIC), which bear 99% of the encephalopathy burden; neither is it listed as a priority research area in global health. Here we explore the major roadblocks that prevent the use of cooling in LMIC, including differences in population comorbidities, suboptimal intensive care, and the lack of affordable servo-controlled cooling devices. The emerging data from LMIC suggest that the incidence of coexisting perinatal infections in NE is no different to that in high-income countries, and that cooling can be effectively provided without tertiary intensive care and ventilatory support; however, the data on safety and efficacy of cooling are limited. Without adequately powered clinical trials, the creeping and uncertain introduction of cooling therapy in LMIC will be plagued by residual safety concerns, and any therapeutic benefit will be even more difficult to translate into widespread clinical use.
authors.affiliation: Centre for Perinatal Neuroscience, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Montaldo
authors.affiliation: Centre for Perinatal Neuroscience, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Shreela S
authors.initials: SS
authors.lastname: Pauliah
authors.affiliation: Centre for Perinatal Neuroscience, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lally
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Linus
authors.initials: L
authors.lastname: Olson
authors.affiliation: Centre for Perinatal Neuroscience, Imperial College London, Hammersmith Hospital, London, UK. Electronic address: s.thayyil@imperial.ac.uk.
authors.forename: Sudhin
authors.initials: S
authors.lastname: Thayyil
mesh_terms: D001238:Asphyxia Neonatorum / Q000628:therapy*; D003906:Developing Countries; D006295:Health Resources / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics / Q000379:methods*; D007231:Infant, Newborn
keywords: Low- and middle-income countries; Neonatal encephalopathy; Neonatal mortality; Therapeutic hypothermia