Ethical Challenges in the Use of Therapeutic Hypothermia in Indian Neonatal Units.
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Date
2010-05
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Abstract
Trials in developed countries have shown that therapeutic hypothermia reduces the risk of death or severe disability in
infants with neonatal encephalopathy. Cooling has been adopted as a standard of care in some parts of the world. Some
Indian neonatal units have considered or even embarked upon cooling encephalopathic term newborn infants. In this
article we discuss some of the potential ethical questions that should be considered before introducing therapeutic
hypothermia in an Indian setting. Evidence from previous trials may not be relevant given significant differences in the
epidemiology of neonatal encephalopathy in countries like India. There is a possibility that hypothermia would be
ineffective or harmful. The most appropriate way to answer these concerns would be to perform a large randomized
controlled trial of cooling in India. However, such trials will also raise potential ethical challenges. Cooling may also affect
decisions about treatment withdrawal, and may create uncertainty about prognosis. It may exacerbate ethical problems
relating to lack of neonatal intensive care bed space.
Description
Keywords
Cooling, Therapeutic, Ethics, Hypothermia, Hypoxia-Ischemia, Newborn, India
Citation
Wilkinson Dominic J, Singh Meharban, Wyatt John. Ethical Challenges in the Use of Therapeutic Hypothermia in Indian Neonatal Units. Indian Pediatrics. 2010 May; 47(5): 387-393.