Core temperature after birth in babies with neonatal encephalopathy in a sub-Saharan African hospital setting

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dc.contributor.authorEnweronu-Laryea, Christabel
dc.contributor.authorMartinello, Kathryn A.
dc.contributor.authorRose, Maggie
dc.contributor.authorManu, Sally
dc.contributor.authorTann, Cally J.
dc.contributor.authorMeek, Judith
dc.contributor.authorAhor-Essel, Kojo
dc.contributor.authorBoylan, Geraldine B.
dc.contributor.authorRobertson, Nicola J.
dc.contributor.funderUniversity College Londonen
dc.contributor.funderNational Institute for Health Researchen
dc.date.accessioned2019-07-30T10:50:26Z
dc.date.available2019-07-30T10:50:26Z
dc.date.issued2019-06-05
dc.description.abstractKey points: Therapeutic hypothermia (HT) to 33.0–34.0°C for 72 h provides optimal therapy for infants with neonatal encephalopathy (NE) in high-resource settings. HT is not universally implemented in low- and middle-income countries as a result of both limited resources and evidence. Facilitated passive cooling, comprising infants being allowed to passively lower their body temperature in the days after birth, is an emerging practice in some West African neonatal units. In this observational study, we demonstrate that infants undergoing facilitated passive cooling in a neonatal unit in Accra, Ghana, achieve temperatures within the HT target range ∼20% of the 72 h. Depth of HT fluctuates and can be excessive, as well as not maintained, especially after 24 h. Sustained and deeper passive cooling was evident for severe NE and for those that died. It is important to prevent excessive cooling, to understand that severe NE babies cool more and to be aware of facilitated passive cooling with respect to the design of clinical trials in low- and mid-resource settings. Abstract Neonatal encephalopathy (NE) is a significant worldwide problem with the greatest burden in sub-Saharan Africa. Therapeutic hypothermia (HT), comprising the standard of care for infants with moderate-to-severe NE in settings with sophisticated intensive care, is not available to infants in many sub-Saharan African countries, including Ghana. We prospectively assessed the temperature response in relation to outcome in the 80 h after birth in a cohort of babies with NE undergoing ‘facilitated passive cooling’ at Korle Bu Teaching Hospital, Accra, Ghana. We hypothesized that NE infants demonstrate passive cooling. Thirteen infants (69% male) ≥36 weeks with moderate-to-severe NE were enrolled. Ambient mean ± SD temperature was 28.3 ± 0.7°C. Infant core temperature was 34.2 ± 1.2°C over the first 24 h and 35.0 ± 1.0°C over 80 h. Nadir mean temperature occurred at 15 h. Temperatures were within target range for HT with respect to 18 ± 14% of measurements within the first 72 h. Axillary temperature was 0.5 ± 0.2°C below core. Three infants died before discharge. Core temperature over 80 h for surviving infants was 35.3 ± 0.9°C and 33.96 ± 0.7°C for those that died (P = 0.043). Temperature profile negatively correlated with Thompson NE score on day 4 (r2 = 0.66): infants with a Thompson score of 0–6 had higher temperatures than those with a score of 7–15 (P = 0.021) and a score of 16+/deceased (P = 0.007). More severe NE was associated with lower core temperatures. Passive cooling is a physiological response after hypoxia–ischaemia; however, the potential neuroprotective effect of facilitated passive cooling is unknown. An awareness of facilitated passive cooling in babies with NE is important for the design of clinical trials of neuroprotection in low and mid resource settings.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationEnweronu‐Laryea, C., Martinello, K.A., Rose, M., Manu, S., Tann, C.J., Meek, J., Ahor‐Essel, K., Boylan, G.B. and Robertson, N.J., 2019. Core temperature after birth in babies with neonatal encephalopathy in a sub‐Saharan African hospital setting. The Journal of Physiology. (11pp). DOI:10.1113/JP277820en
dc.identifier.doi10.1113/JP277820en
dc.identifier.eissn1469-7793
dc.identifier.endpage12en
dc.identifier.issn0022-3751
dc.identifier.journaltitleJournal of Physiologyen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8262
dc.language.isoenen
dc.publisherBlackwell Publishing Ltden
dc.relation.urihttps://physoc.onlinelibrary.wiley.com/doi/full/10.1113/JP277820
dc.rights© 2019 The Authors.The Journal of Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society. This is an open access article under Attribution 4.0 International licence.en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectNeonatal encephalopathy (NE)en
dc.subjectTherapeutic hypothermia (HT)en
dc.subjectInfantsen
dc.titleCore temperature after birth in babies with neonatal encephalopathy in a sub-Saharan African hospital settingen
dc.typeArticle (peer-reviewed)en
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