Journal of Neonatal Biology

Providing therapeutic hypothermia using phase changing device to neonates with perinatal asphyxia in resource limited setting: kenyatta national hospital, nairobi, experience

International Conference and Expo on Neonatology and Perinatology - June 06, 2022 | Webinar

June 06, 2022 | Webinar

A Wasunna

Department of Paediatrics and Child Health, University of Nairobi, Kennya

Scientific Tracks Abstracts: J Neonatal Biology

Abstract:

P Perinatal asphyxia remains a major contributor of neonatal mortality and morbidity in LMIC. While the incidence is as low as 1/1000 live births in the developed countries, this remains high in the Low- and Middle-Income Countries (LMIC), where it can be as high as 100 to 126/1000. It is also a major contributor to neonatal mortality and all disability in children. Therapeutic Hypothermia in presence of adequate supportive care has now been established to improve outcome in babies who have suffered moderate and severe perinatal asphyxia. This is in terms of short term morbidity and mortality as well as long term neurodevelopmental outcome. The modalities used to provide TH are generally unaffordable in the LMIC. Whole body cooling using Phase Changing Material (PCM) blocks has been shown to produce results similar to that where expensive equipment is used. It is hypothesised that PCM device can be used successfully in a low resource neonatal unit. Results A total of 35 babies were put on TH and 35 given the standard care only. The two groups were comparable in terms of sex, maternal age and education, pregnancy complications, mode of delivery and Sanart staging (p 0.414 – 0.78) A steady rectal temperature within the target range (33-340 C) was achieved and maintained for 72 HRS in the TH group before successful rewarming over a period of 10 hours. The 95% CI for each mean target temperature was a little wider than that from other studies, largely because the room used for this study was also a busy one with lots of movement, hence difficult to control the ambient temperature. Each of the four day Thompson score were significantly better in the TH group for both moderate and severe asphyxia beyond day 1 ( p <0.001). Complications of PHT, severe mixed acidosis, sepsis, seizures, hyperglycemia , DIC occurred among TH babies while sepsis, seizures, AKI, NEC, PHT, DIC, PVL, apnoeic episodes, jaundice, bradycardia were in the non TH babies. Seven babies died among the TH group, all with severe HIE – 4 within 3 days of life, 3 having severe PHT and one with DIC. Six babies among the non- TH died, only 3 within 4 days of life, all with severe HIE. These three had NEC (1), severe PHT (2) Conclusions This study demonstrated that it is possible to provide TH with good results using a simple but effective PCM device in a setting with limited resources.