Newborn hypoxia cooling therapy is questioned

Studies in rich countries have shown that cooling babies who are born deprived of oxygen can prevent brain damage and other health problems
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Joanne Davidson, a fetal physiologist at the University of Auckland in New Zealand, said the findings recently published in The Lancet-Global Health were surprising because researchers conducted trials in 7 "well-equipped" hospitals
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Sudhin Thayyil, a perinatal neuroscientist at Imperial College London, UK, led the study.
He believes that hypothermia should be immediately suspended in low- and middle-income countries before further research can pinpoint why this treatment causes more deaths.

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This cooling technique is called therapeutic hypothermia and is used to treat babies who are born at or near term and are hypoxic at birth
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In 2015, international guidelines recommended that hypoxic infants in low- and middle-income countries should cool down under strict conditions, but at the same time, they acknowledged that the supporting evidence is still insufficient
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To test this treatment, the researchers randomly assigned 202 full-term infants from Sri Lanka, India, and Bangladesh with suspected brain injury to receive a 3-day cooling treatment; at the same time, 206 infants received standard treatment without cooling
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In contrast, a 2009 study of 325 babies born in the UK found that the mortality rate of cooled and non-cooled infants after 18 months was about 26%, but treatment significantly reduced the disability and disability of survivors.
Risk of movement disorders
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David Edwards, a neonatologist at King's College London, said it is not easy to reveal why this method is more successful in some countries than in others
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Edwards said that a reasonable explanation is that even minor fetal infections during pregnancy (more common in low- and middle-income countries and may not be detected) can affect the baby's brain before or before birth
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"These babies do not show the same injury pattern as in the first world environment, and we need to understand why this is
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Cooling therapy proves what Davidson calls the danger of "treating creep": when clinical practice becomes widespread, there is no evidence that its benefits are universal
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"Once something enters clinical practice, it is difficult to remove it from clinical practice, and it is even difficult to go back and do appropriate randomized controlled trials
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" She said
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But Marianne Thoresen, a neonatal neuroscientist at the University of Bristol in the United Kingdom, does not believe that this practice should be stopped in low- and middle-income countries
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She said that the higher mortality rate may not be directly caused by cooling; to some extent, it may be related to the level of care for each baby
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The nurses in this study looked after 2 to 4 babies at a time, while nurses in high-income countries usually only looked after one baby who received cooling treatment
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Dedicated care can prevent death while retaining the cooling benefits seen in research, such as improved exercise performance and reduced cases of cerebral palsy
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"These babies need very high-quality intensive care, because when you cool someone down, many physiological functions are affected,
" she said
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Edwards said there is now greater incentive to work with researchers in low- and middle-income countries to find a treatment that does not involve cooling
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"These results should not discourage us
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" said Samamali Sumanasena, a pediatric disease expert at Kelaniya University in Sri Lanka and co-author of the study.
"We must look forward to see which factors contribute to the mortality rate and how to minimize it.
Chemical
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” (Source: Jin Nan, China Science News)

Related paper information: https://doi.
org/10.
1016/S2214-109X(21)00264-3