Hypoxic ischaemic encephalopathy in infants

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c397 (Published 09 February 2010) Cite this as: BMJ 2010;340:c397
  1. Rosemary D Higgins, programme scientist and medical officer1,
  2. Seetha Shankaran, professor of paediatrics2,
  3. Abbot R Laptook, professor of paediatrics3
  1. 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
  2. 2Wayne State University, Detroit, MI 48201, USA
  3. 3Women and Infants’ Hospital of Rhode Island, Brown University, Providence, RI 02905, USA
  1. 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 …

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