1. One of the objectives of the study was to
examine the adherence of various units to the standard established
cooling protocol. This is not answered in results. The author
described it under broad heading of criteria for cooling. There is
no clarity on definition or description of clinical criteria used by
various units.
2. Majority of the units are using clinical
criteria alone as deciding factor for cooling without giving due
consideration to cord blood gas. Clinical criteria like Apgar scores
and need of resuscitation are prone to subjective bias. It is better
to use cord blood gas as criteria to define intrapartum asphyxia.
3. It is important to emphasize here that
therapeutic hypothermia is not a standard of care as of now in our
country, and in view of lack of long-term data on efficacy in LMIC,
it is necessary to take written informed consent from the parents
before offering it [2,3].
4. It will be important to know that out of the
47 units practicing therapeutic hypothermia, how many have the
facility for long-term follow up for timely recognition of
neurodevelopmental disabilities and institution of early stimulation
program.
5. It is alarming that in private sector 65% of
the cooling is done by using indigenous devices, which might be less
efficacious and even harmful [4]. Also, one-fourth of the surveyed
private centers are using therapeutic hypothermia beyond initial 6
hours, which may not be justified.
6. Authors rightly stated that there is need to
develop national guidelines for therapeutic hypothermia. However, we
still do not have sufficient evidence on safety as well as efficacy
in LMIC to formulate the guidelines. There is an urgent need for
randomized trials along with long-term follow up to have more
clarity on this issue. In the absence of the national guidelines, it
must be practiced under strict trial protocols.