• 1 Department of Neonatology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
  • 2 Department of Neonatology, University of Texas Southwestern Medical Centre, Dallas, Texas, USA
  • 3 Department of Neonatology, Cloudnine Hospitals, Bangalore, India
  • 4 Centre for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
  • 5 Neonatal Unit, Fiona Stanley Hospital, Perth, Washington, Australia
  • 6 Department of Neonatology, Hospital Tunku Azizah, Wilayah Persekutuan, Kuala Lumpur, Malaysia
  • 7 Department of Paediatrics, Siriraj Hospital, Bangkok, Thailand
  • 8 Division of Neonatology, Department of Pediatrics, Guangzhou Women's and Children's Hospital, Guangzhou, China
  • 9 Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
  • 10 Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
  • 11 Department of Paediatrics, Universitas Gadjah Mada, Jogjakarta, Indonesia
  • 12 Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
  • 13 Department of Neonatology, Ulsan University Hospital, Ulsan, Republic of Korea
Neonatology, 2022;119(6):712-718.
PMID: 36202069 DOI: 10.1159/000526404


INTRODUCTION: We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE).

METHODS: A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries.

RESULTS: A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH.

CONCLUSIONS: This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling" an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.