Therapeutic hypothermia for hypoxic ischemic encephalopathy in neonates born at or beyond 36 weeks and neurodevelopmental outcomes

Objectives. To evaluate neurodevelopmental outcomes—including cognitive, motor, and language development—in infants with hypoxic-ischemic encephalopathy (HIE) who received servo-controlled therapeutic hypothermia (TH) and reached the age of 18 to 24 months. Materials and methods. This prospective study, conducted at Sarji Maternal and Child Hospital in Shivamogga, assessed children using the Bayley Scale of Infant and Toddler Development 4 (BSID-IV), during follow-up visits and, when necessary, home assessments. Data were analyzed using SPSS v23. Categorical variables were compared using chi-square tests, while continuous variables were analyzed with independent t-tests. Statistical significance was set at p < 0.05. All neonates who successfully underwent therapeutic hypothermia were included in the study. Infants lost to follow-up or whose parents did not provide consent were excluded. Results. Of the 47 babies who underwent TH for moderate asphyxia-associated encephalopathy, 32 were followed up, either in the high-risk neonatal clinic or at home. The other 15 children were lost to follow-up, which limits the generalizability of the findings. Among the 32 evaluated infants, 6 (18.8%) demonstrated moderate to severe developmental delay, while 26 (81.2%) showed either mild delay or normal development according to BSID-IV. Conclusion. The neurodevelopmental outcomes observed were comparable to those reported in major international or landmark trials utilizing the BSID as a preferred neurodevelopmental evaluation tool. These findings support the continued use of therapeutic hypothermia in low- and middle-income countries (LMICs), like India, especially in cases of moderate asphyxia-related encephalopathy, with the potential to improve developmental outcomes and quality of life. Continued long-term follow-up into adolescence and adulthood is recommended to better understand the extended impact of this intervention.