Hypoxic ischaemic encephalopathy in infants

doi:10.1136/bmj.c397

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Rosemary D Higgins, programme scientist and medical officer1,
Seetha Shankaran, professor of paediatrics2,
Abbot R Laptook, professor of paediatrics3

¹Pregnancy and Perinatology Branch, Center for Developmental Biology and Perinatal Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
²Wayne State University, Detroit, MI 48201, USA
³Women and Infants’ Hospital of Rhode Island, Brown University, Providence, RI 02905, USA

higginsr{at}mail.nih.gov

Cooling shows promise in reducing death and disability

The meta-analysis by Edwards and colleagues (doi:10.1136/bmj.c363) assesses whether moderate hypothermia improves survival and neurological outcome at 18 months of age in children who have experienced hypoxic ischaemic encephalopathy.1 Data from three large trials of almost 800 infants showed a significant reduction in the combined outcome of death and disability in infants undergoing either head cooling or whole body cooling (risk ratio 0.81, 95% confidence interval 0.71 to 0.93; number needed to treat 9, 5 to 25).1 2 3 4

Many questions remain though. Ideally treatment should be targeted at infants most likely to benefit, but how can they be identified? Because hypoxic ischaemic encephalopathy is a rare disease, meta-analysis of data from individual patients may help determine the answer to this question.

Can cooling begin before arrival at the specialist centre? Results from …