P1.202: Feasibility and Challenges of Low-Complexity Therapeutic Hypothermia for Neonates with Hypoxic-Ischemic Encephalopathy in a Resource-Limited Setting

Background: Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality, particularly in low-resource settings where access to servo-controlled therapeutic hypothermia (TH) is limited. Low-complexity cooling methods have been proposed as alternatives, but their effectiveness in achieving and maintaining therapeutic temperatures remains uncertain. This study describes the clinical characteristics and short-term outcomes of neonates with HIE treated with low-complexity hypothermia in a public hospital in Peru.

Methods: We conducted a retrospective case series including neonates ≥36 weeks’ gestation with moderate-to-severe HIE who received low-complexity TH at Hospital Nacional Cayetano Heredia (2018–2024). Clinical data included time to initiate cooling, time to reach target temperatures (34–35°C), duration of hypothermia, and associated complications. HIE severity was classified using the Sarnat or Thompson criteria. Descriptive statistics were used for data analysis.

Results: Thirteen neonates were included (77% male, median gestational age: 38 weeks [IQR: 37–39], median birth weight: 3565 g [IQR: 3020–3640]). Maternal comorbidities were present in 46% of cases, including urinary tract infections, cocaine base paste use, cord prolapse, and premature rupture of membranes. All neonates required resuscitation, and 54% had an Apgar score < 5 at 5 minutes. Hypothermia was initiated at a median of 103 minutes post-birth (IQR: 66–146). The time to achieve 35°C ranged from 56 minutes to 9 hours 43 minutes (median: 3h 13min), and 34°C from 56 minutes to 11 hours 43 minutes (median: 3h 33min). Only 69.2% reached 34°C within six hours, and 31% maintained it for the recommended 72 hours. The median hypothermia duration was 75 hours, with a rewarming period of 5–15 hours. Hospitalization lasted a median of 13 days (range: 2–60). All neonates required sedation and ventilatory support; 77% received antibiotics, 46% required inotropes, and 15% received anticonvulsants. Complications occurred in 23% of cases (pneumothorax, coagulation disorders, seizures). The mortality rate was 15.4% (n=2), with deaths occurring within the first days of hospitalization.

Conclusion: Low-complexity hypothermia achieved partial adherence to target temperature recommendations but faced challenges in maintaining stable cooling. While mortality rates were comparable to studies using servo-controlled TH, significant temperature fluctuations were observed. The difficulty in maintaining consistent therapeutic hypothermia highlights the need for improved monitoring and protocol optimization in resource-limited settings. Further research is needed to evaluate long-term neurological outcomes and to enhance the efficacy of low-complexity TH in low-income regions.