Therapeutic Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy (HIE) in Low- and Middle-Income Countries (LMIC's): Challenges and Opportunities

Perinatal Asphyxia is the third major cause of neonatal mortality and morbidity worldwide: more so in LMIC’s which bear almost 98% of global incidence of Perinatal Asphyxia. The involvement of brain in Perinatal Asphyxia, called Hypoxic Ischemic Encephalopathy (HIE), occurs in 1 up to 3 per 1000 live births in high-income countries, and in up to 20 per 1000 live births in LMIC’s [1]. Untreated HIE has very high mortality (up to 62%) and very high morbidity in survivors (Cognitive and developmental delay or learning difficulties 45%, Cerebral Palsy 29%, Blindness or vision defects 26%, Gross motor, coordination problems and epilepsy 17%, hearing loss or deafness 9%, and behavioural issues 1%) [1]. The socioeconomic and psychological consequences of these morbidities are very high; both for the sufferers and their families as well as the health system.