Therapeutic hypothermia for hypoxic-ischemic encephalopathy: challenges during transfer and global perspectives.

Perinatal asphyxia resulting in hypoxic--ischemic encephalopathy (HIE) occurs in 1--2/1000 live births in high income countries, and 10--20/1000 in lowand middleincome countries (LMICs). Worldwide, HIE affects around 2.7 million newborn infants, of whom 690,000 die. Over half of survivors go on to develop cerebral palsy, epilepsy, and other forms of lifelong neurological disability. The adoption of therapeutic hypothermia (TH) in high-income countries has been one of the most significant advances in neonatal care over the past 20 years, and follows rigorous basic science and clinical research. The meta-analysis of the clinical trials showed a remarkable consistency toward the benefit of TH in both mortality and neurodisability. It may surprise, however, given the global burden of HIE and relative simplicity of the treatment, that TH has not been universally adopted outside high income countries. The reasons for this are complex and multifactorial. The idea of cooling an infant following perinatal asphyxia is not new. A quick survey of the literature will bring up the work of James Miller from New Orleans and Bjorn Westin