‘Treatment for brain damaged babies is risky’
A PROCEDURE widely used to treat birth-related brain damage in new-born babies in low and middle income (LMICs) countries may increase the risk of death, a new study conducted largely in India reported on Tuesday (3).
The research, led by Imperial College London, together with several hospitals in India, Sri Lanka and Bangladesh, and published in the journal The Lancet
Global Health used a technique called therapeutic hypothermia with 408 babies with suspected birth-related brain damage. This technique cools a baby’s body temperature by four degrees, by placing them on a type of cooling mat.
“These data, from the HELIX trial, suggest therapeutic hypothermia, alongside high-quality intensive care treatment, does not reduce the risk of brain injury or death in LMICs,” said Professor Sudhin Thayyil, lead author of the trial from Imperial College London’s Department of Brain Sciences.
“The findings also suggest the treatment may increase the risk of death, compared to babies who did not receive the treatment. Hence, hypothermia treatment should no longer be used as a treatment for neonatal encephalopathy in low- and middle-income nations,” he said.
Prof Thayyil called for the international guidelines from ILCOR, the International
Liaison Committee on Resuscitation, on cooling therapy in LMIC to be “immediately amended” based on the findings.
He added: “Covid-19 has exposed how some diseases affect disadvantaged populations differently. It is possible that ethnicity, socioeconomic status, infection and nutritional status, for example, could influence birth-related brain injury, even in high income countries, and thus not all will respond to the same treatment.”
Neonatal encephalopathy is the cause of one million deaths worldwide every year, of which 99 per cent occur in low and middle income (LMICs) countries .
Professor Jayshree Mondkar, a senior author and professor of neonatology and ex-dean of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, said: “The HELIX trial results were surprising as many centres in India are routinely cooling babies. But the trial
was conducted to a very high standard, and the results are convincing.”
Babies in both groups received comprehensive treatment in intensive care units. The cooling treatment was initiated within six hours of birth, and continued for 72 hours, while the babies were closely monitored.
An advanced MRI scan was used to assess their brain health at two weeks old, and the babies’ general health at 18
months. Gauging the level of a child’s development and disability is difficult before this age.
The results of the trial showed that 50 per cent of the infants in the group who received the cooling treatment died or had moderate or severe disability. In the control group, where the babies didn’t receive the cooling treatment, 47 per cent of infants died or had a moderate or severe disability.