title: Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy had favourable outcomes at a referral hospital in a middle-income country.
abstract: OBJECTIVE
  This South African study documented the survival and neurodevelopmental outcomes of infants with hypoxic-ischaemic encephalopathy (HIE) after introducing cooling to a neonatal intensive care unit and identified early markers for neurodevelopmental outcome.
  
  
  METHODS
  We retrospectively reviewed infants that received cooling according to the Total Body Hypothermia trial protocol from 2008 to 2011. Infants were screened with the Bayley Scales of Infant and Toddler Development, Third Edition, at one year of age and underwent neurological and hearing assessments.
  
  
  RESULTS
  Data on 99 infants with HIE showed that 45% of cases were moderate, 23% severe and 32% mild. An abnormal amplitude integrated electro-encephalogram (aEEG) background was documented in 45 cases within 24 hours. Magnetic resonance imaging (MRI) scans were consistent with HIE in all but one case. We reviewed 50 traceable survivors at one year. Development was significantly impaired in nine and 41 were normal or mildly impaired. A severely abnormal aEEG background, severe HIE and an abnormal MRI were associated with death and severe impairment. A good suck, mild HIE, primiparity and normal MRI were associated with good outcomes.
  
  
  CONCLUSIONS
  Most infants with HIE survived without major impairment. Previously described predictors of neurodevelopmental outcome were good surrogate markers in this population.
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.|Division of Bioengineering and Imaging Sciences, Department of Perinatal Imaging and Health, 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; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D020925:Hypoxia-Ischemia, Brain / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Middle-income country; Neonatal encephalopathy; Outcome; Predictors; Therapeutic hypothermia