Therapeutic Hypothermia (TH) for Neonatal Hypoxic Ischemic Encephalopathy (HIE) in Low- and Middle-Income Countries (LMIC's): Efficacy and Safety of Ice Gel Packs as a Low-Cost Tool

Aim: To assess the efficacy and safety of ice gel packs as a manual method of therapeutic hypothermia in Term and Near-Term newborn infants admitted with Moderate and Severe Hypoxic Ischemic Encephalopathy. Background: TH is a standard prophylactic neuroprotective therapy for Neonatal HIE. TH can be provided either by servo-controlled method (which is expensive) or by manually controlled method (which is inexpensive). This manuscript shares our experience of use of Ice Gel packs as a manual method of TH. The findings have implications for LMIC’s. Material and Methods: A retrospective cross sectional observational study was carried out in tertiary care NICU of Dr. Sulaiman Al Habib Hospital Al Qassim KSA. Demographic and clinical data was collected, on pre-approved Performa, using patient electronic health records. The data items included hourly temperature record, neurological examination, relevant labs and MRI results. The data was tabulated and analyzed by SPSS version 23 (IBM Corp, Amonk, NY, USA) software. Results: 23 neonates, born between 2020 and 2023, and admitted with a diagnosis of moderate to severe HIE and provided cooling therapy using Ice gel packs, were included in the study. In all babies, core body temperature was effectively controlled between 330 C and 340 C for 72 hours followed by a very smooth slow rewarming to normal temperature over a period of eight hours. There was no mortality and no significant long term morbidity. The neurodevelopmental examination was normal on discharge and on follow up after one month. Conclusion: Ice gel packs are a safe and effective low-cost method of achieving target therapeutic hypothermia in newborn babies with Hypoxic Ischemic Encephalopathy. The finding has significant clinical and financial implications for newborn care in LMIC.