"Mild'' Hypoxic-Ischaemic Encephalopathy and Therapeutic Hypothermia: A Survey of Clinical Practice and Opinion from 35 Countries

Mani Singla, Lina Chalak, Kishore Kumar, Masahiro Hayakawa, Shailender Mehta, Siew Hong Neoh, Ratchada Kitsommart, Yuan Yuan, Huayan Zhang, Prakesh S. Shah, John Smyth, Setya Wandita, Kee Thai Yeo, Gina Lim, Ju Lee Oei

Research output: Contribution to journalArticlepeer-review


Introduction: We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE). Methods: A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries. Results: A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH. Conclusions: This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling"an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported.

Original languageEnglish (US)
Pages (from-to)712-718
Number of pages7
Issue number6
StatePublished - Dec 1 2022


  • Mild hypoxic-ischaemic encephalopathy
  • Neonatal encephalopathy
  • Perinatal asphyxia
  • Survey
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Biology


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