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Cooling works

My fellow deity Hyperion (who writes the Highlights column for Archives' Fetal and Neonatal edition) and I thought that this was a neonatal follow-up paper that non-neonatologists should know about. The UK-based TOBY study started in 2002, and set out to determine the effectiveness of whole-body (as opposed to head-only) cooling in term newborns with birth asphyxia. Those randomised had signs of moderate or severe hypoxic-ischaemic encephalopathy. The intervention group were cooled to a rectal temperature of 33–34°C using a cooling blanket for 72 hours, starting within 6 hours of birth. Controls received standard care at normal temperatures. Significantly improved short-term developmental outcomes in the cooled group have already been reported. This paper reports detailed neurological and developmental outcomes at age 6 to 7 years (Azzopardi D and colleagues. NEJM 2014;371:140–9). They were able to study 277 survivors of the 325 originally randomised, an impressively high proportion. The cooled group were significantly more likely to have survived with an IQ score of >85 (52% vs, 39%; relative risk 1.31; p=0.04), and without a neurological abnormality (45% vs 28%; RR 1.6; 95% CI 1.1–2.2). The cooled group had a significantly lower rate of cerebral palsy (21% vs. 36%; …

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