DOI: https://doi.org/10.53350/pjmhs2023171266 ORIGINAL ARTICLE 266 P J M H S Vol. 17, No. 01, January, 2023 The Short Term Outcome of Therapeutic Hypothermia Compared with Standard Treatment among Asphyxiated Newborns Presenting after 6 hours of Life JAVED LAAL 1 , ZUNAIRA JAVAID 2 , MUHAMMAD ANWAR 3 , AMJAD IQBAL 4 , AMEER AHMAD 5 1 Senior Registrar Pediatrics, BVH Bahawalpur 2 Senior Registrar Pediatrics, BVH Bahawalpur 3 Associate Professor Neonatology, Quaid e Azam Medical College Bahawalpur 4 Assistant Professor Paeds 5 Professor of Pediatrics, Quaid e Azam Medical College BWP Correspondence to: Dr Muhammad Anwar, Email: hmanwar157@yahoo.com, Cell: 03216820943 ABSTRACT Objectives: To compare the short term outcome of therapeutic hypothermia in asphyxiated newborn with standard treatment presenting after 6 hours of life. Methodology: It was Randomized controlled trial conducted in the department of Pediatric Medicine, Bahawal Victoria Hospital, Bahawalpur from December 2018 to June 2019 after taking ethical approval from institutional ethical review committee and informed written consent from parents of patients. Confidentiality of the data was maintained and it was assured that no harm to study participants is done. A total of 108 term neonates with moderate to severe HIE presenting >6 hours of life were included. Preterm infants, major congenital anomaly and overt bleeding were excluded. Then selected patients were placed randomly into Group A (hypothermia group) & Group B (conservative group), by using lottery method. Outcome variable like mortality within 1 st week was noted. There was no conflict of interest in the study and funding was done by the authors. Results: The mean age of patients in group A was 17.69 ± 6.68 hours and in group B was 17.60 ± 6.65 hours. Out of 108 patients, 62 (57.41%) were males and 46 (42.59%) were females with male to female ration of 1.3:1. There was mortality within one week (short term outcome) in 07 (12.96%) patients in Group A (hypothermia group) while in Group B (conservative group), it was seen in 16 (29.63%) patients. Conclusion: This study concluded that there is benefit of therapeutic hypothermia in asphyxiated newborns after 6 hours of life and short term outcome is better after therapeutic hypothermia in asphyxiated newborns. Keywords: Asphyxia, Encephalopathy, Mortality, Cooling. INTRODUCTION Hypoxic-ischemic encephalopathy (HIE), another name for perinatal asphyxia, is characterised by biochemical and clinical signs of acute or subacute brain injury brought on by smothering, hypoxia, acidosis, and hypoperfusion. The key factor contributing to morbidity and mortality is neonatal birth asphyxia. Birth asphyxia incidence in wealthy countries is approximately 0.5-1/1000 live births, compared to the range of 100-250/1000 live births in underdeveloped countries, due to superior perinatal and prenatal care. 1 . Each year, 1.1 million stillbirths and around a million newborn deaths are attributed to birth asphyxia 2 . Birth asphyxia is to blame for 23% of all newborn fatalities worldwide 3 . In Pakistan, birth asphyxia is the secondary cause of 64% of neonatal deaths. How many newborns experience birth asphyxia and go on to have severe neurophysical developmental issues, such as cerebral palsy, is still not known with accuracy 5 . The majority of deliveries in underdeveloped nations, including Pakistan, take place at home, and there are no accurate data available to calculate the disease burden in these nations. Neonatal fatalities and birth asphyxia may have a far greater impact than previously thought. Pakistan is one of the 10 developing nations that account for two thirds of all newborn fatalities worldwide 2 . Hypoxic ischemic encephalopathy causes 20–30% of neonatal fatalities, and it also causes lasting neurological problems in 33–50% of survivors (cerebral palsy and mental retardation) 6 . An estimated 14.5% of cerebral palsy cases are linked to intrapartum hypoxic-ischemia. 7 Neonatals respond by shifting and maintaining perfusion to the body's important organs once compensatory mechanisms are triggered in response to the birth asphyxia. When the brain's auto- regulatory mechanisms break down, blood flow to the cerebral regions depends on the systemic blood pressure, which has already been compromised by the asphyxia insult. This leads to cerebral ischemia, which ultimately results in primary energy failure, a drop in brain temperature, and the release of inhibitory neurotransmitters like GABA as a body's defence mechanism to reduce the impact of hypoxia. The initial energy failure and early cell death period can last up to twenty-four hours, giving doctors a window of opportunity. It typically lasts for roughly six hours. Secondary energy failure and reperfusion injury cause neuronal death through apoptosis, which has long-term neurodevelopmental repercussions in the event that the clinician does not step in and help. After severe neonatal hypoxic ischemia, hypothermia is a therapeutic technique that lessens secondary neuronal impairment. Although there have been reports on the diversity of prenatal hypoxia and different cooling techniques, consistent data show that hypothermia lessens brain damage and increases survival without handicap. Hypothermia after HIE is found to have a therapeutic benefit with a relative risk of 0.76 (95% C.I., 0.65- 0.89) for neurodevelopmental impairment and death 8. Because we are located in a third-world country with limited health care facilities, an ineffective referral system, and inadequate and incorrect perinatal care services, the majority of babies delivered outside of our area arrive at our hospital after six hours, and there are no studies that demonstrate the effectiveness of therapeutic hypothermia at that point in time. Given that the problem of primary and secondary energy failure is connected to the delay in presentation, we were interested in determining whether there is any benefit for newborns brought to units after 6 hours and comparing the results. The two therapy modalities would be contrasted, and the one that produced the best outcomes would be used extensively. MATERIAL AND METHOD It was a randomized controlled trial conducted in Pediatric Medicine Department of Bahawal Victoria Hospital, Bahawalpur from December 2018 to June 2019 after taking ethical approval from institutional ethical review committee. Sample size calculated for the study anticipating the therapeutic benefit of hypothermia after HIE on neurodevelopmental disability and death with a relative risk of 0.76 (95% C.I, 0.65-0.89) 8 , power of the study 80% and ratio of case to control 1:1 was 108 (54 in each group). Total 108 term newborns (37-42 weeks of gestation), with moderate to severe HIE presented after six hours of life were included in the study through non probability consecutive sampling technique. The