A survey on the diagnosis and management of neonatal hypoxic ischaemic encephalopathy in sub-saharan Africa

Sub-Saharan Africa (SSA) has the highest burden of neonatal hypoxic ischemic encephalopathy (HIE) in the world. However, there are few descriptions of HIE management in SSA and therapeutic hypothermia (TH) is considered controversial. A web-based survey was distributed to doctors across SSA in 2023. Adequate responses were received from 136 doctors across 43 of 48 countries. Therapeutic hypothermia was available in 13 countries, most frequently in private institutions compared to other settings (69% vs. 28%; P = 0.004). Over 90% of respondents who provided TH, appropriately cooled neonates to rectal temperatures of 33.5 °C before age 6 h, for 72 h, and 79% used automated cooling methods. Intubated ventilation and electroencephalograms were more available where TH was used (81% vs. 55%; p = 0.004 and 65% vs. 8%; p < 0.001 respectively). Indicators of intrapartum hypoxia were more frequently defined with TH provision, including early pH (79% vs. 21%; p < 0.001), base deficit (76% vs. 20%; p < 0.001), and ventilation at age 10 min (87% vs. 53%; p = 0.001). Despite the variation in resources and management of HIE, most respondents had standardised protocols (76%). Most respondents who provided TH, followed evidence-based methods, and had stricter criteria and more resources than institutions who did not cool.