title: Management of therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy in a tertiary centre in South Africa.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Tygerberg Children's Hospital, Cape Town, South Africa.
authors.forename: Gugulabatembunamahlubi Tenjiwe Jabulile
authors.initials: GT
authors.lastname: Kali
authors.affiliation: Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Department of Paediatrics, Hammersmith Hospital, Imperial College, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Martinez-Biarge
authors.affiliation: Tygerberg Children's Hospital, Cape Town, South Africa.
authors.forename: Jeanetta
authors.initials: J
authors.lastname: Van Zyl
authors.affiliation: Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Tygerberg Children's Hospital, Cape Town, South Africa.
authors.forename: Johan
authors.initials: J
authors.lastname: Smith
authors.affiliation: 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.
authors.forename: Mary
authors.initials: M
authors.lastname: Rutherford
mesh_terms: D000293:Adolescent; D000328:Adult; D001831:Body Temperature; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Monitoring; Neonatology; Temp Regulation