Global application of therapeutic hypothermia to treat perinatal asphyxial encephalopathy

Therapeutic hypothermia improves neurodevelopmental outcome following perinatal asphyxial encephalopathy and has now become 'standard of care' in industrialised countries. However, none of the cooling trials so far have been conducted in developing countries, where approximately one million asphyxial deaths occur every year. Use of therapeutic hypothermia in such settings raises several clinical, pragmatic and ethical issues. We suggest that rigorous clinical trials of cooling are required to ensure that a safe and effective neuroprotective therapy demonstrated in high resource settings does not become an unsafe and ineffective practice in low resource settings.