Brain oriented neonatal intensive care requires a high
degree of technical and clinical expertise, sophisticated neuroimaging and
electrophysiological investigations. Such an approach is crucial for
several reasons: (a) the newborn brain is in a developing state and
many of the currently used treatment modalities can cause gross or subtle
brain injury; (b) unlike damage to other organ systems, brain
injuries may not be apparent until several years later and are
irreversible; and (c) long term outcome measurements are lacking in
many neonatal units, particularly in developing countries.
During the history of neonatal medicine, there have
been several instances of inadvertent iatrogenic harm: for example, oxygen
therapy to reduce apnea in the 1940s led to retrolental fibroplasia; more
recently, an increased incidence of cerebral palsy was observed in babies
born to mothers treated with antibiotics for premature labor. By the
nature of the speciality, neonatologists are always keen to embrace the
latest treatment modalities available; unfortunately many of these come at
a price, which may not be apparent unless rigorous scientific evaluation
is undertaken.
Moreover, certain therapies that are safe and
efficacious in one setting may be unsafe in another. One such therapy that
has recently emerged from bench to bedside in developed countries is
therapeutic hypothermia; however, extrapolation of the evidence that this
is a safe and effective therapy in low resource and translational
countries is problematic and clinicians should adhere to the principle of
‘do no harm first’
As a part of UCL-India initiative, University College
London conducted two symposia on neonatal neurological investigations and
neuro-protection (www.isnnth.com) in India, in December 2009.
Deliberations from these symposia will be published as a series of
state-of-the-art review articles in Indian Pediatrics, over the
next few months.
The topics covered will include ethical aspects of
therapeutic hypothermia, cranial ultrasound, magnetic resonance imaging
and spectroscopy, cerebral function monitoring, electroencephalography,
optical imaging and near infrared spectroscopy. Many of these
investigations are now available in India, or likely to be used in
clinical practice in the near future.
Competing interest: None.
Funding: ST is funded by the Department of
Health (UK) and Comprehensive Biomedical Research Centre (CBRC),
University College London. NJR is funded by Higher Education Funding
Council for England (HEFCE).
* This symposia is dedicated to the memory of my
father, Dr TV Sudhan, who always wanted me to work for the babies in
India.