Short-Term Complications of Therapeutic Hypothermia in Neonates with Moderate to Severe Hypoxic Ischaemic Encephalopathy at Aga Khan University Hospital, Nairobi
Audu John Ameh*
Neonatologist and Paediatrician at Aga Khan University Hospital, Nairobi, Kenya.
*Corresponding Author: Dr. Audu John Ameh, Neonatologist and Paediatrician at Aga Khan University Hospital, Nairobi, Kenya.
https://doi.org/10.58624/SVOAPD.2026.05.029
Received: May 05, 2026
Published: September 14, 2026
Citation: Ameh AJ. Short-Term Complications of Therapeutic Hypothermia in Neonates with Moderate to Severe Hypoxic Ischaemic Encephalopathy at Aga Khan University Hospital, Nairobi. SVOA Paediatrics 2026, 5:5, 186-196. doi: 10.58624/SVOAPD.2026.05.029
Abstract
Background: Neonatal hypoxic–ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and long-term neurodisability. Therapeutic hypothermia (TH) is neuroprotective but can cause multisystem complications, and evidence of its safety and effectiveness in low- and middle-income country (LMIC) settings is mixed. We evaluated short-term complications associated with TH among neonates with moderate to severe HIE managed at a tertiary neonatal unit in Nairobi.
Methods: We performed a retrospective descriptive review of medical records for neonates gestational age ≥36 weeks with moderate–severe HIE who received TH in the Aga Khan University Hospital NICU between January 2020 and December 2024. Key variables extracted included demographics, HIE severity (Sarnat stage), TH parameters (method, target temperature, duration, rewarming), and short-term complications within 7–10 days (cardiac, respiratory, neurological, haematological, renal, infectious, metabolic, and device-related). Descriptive statistics summarized frequencies and timing of complications; associations with clinical factors were explored using cross-tabulations and logistic regression where appropriate.
Results: Thirty neonates (median gestational age 39 weeks; mean birth weight 3281.7 g; 53.3% female) received TH, predominantly whole-body cooling with target temperature 33.5°C maintained for a median 72 hours. Most infants had moderate HIE (63.3%, Sarnat II). Median time to target temperature was 6 hours. Overall, 63.3% experienced at least one short-term complication. The most frequent complication was electrolyte imbalance (46.7%), followed by neurological events (seizures in 23.3%). Haematological coagulopathy occurred in 13.3%, renal complications (oliguria) in 6.7%, and infectious events in 3.3%. Cardiorespiratory complications were uncommon; bradycardia was the most frequent cardiac event. Device-related and skin issues were infrequent. Median time to onset of complications was 11 hours and median time to resolution was 25 hours. Median hospital stay was 7 days.
Conclusions: In this tertiary Kenyan NICU, TH was implemented timely and according to protocol, but was associated with a high rate of transient multisystem complications—most commonly electrolyte disturbances and seizures. The observed safety profile is broadly comparable to reports from high-income settings, suggesting that with adequate monitoring, trained staff, and supportive care, TH can be feasibly and relatively safely delivered in well-resourced LMIC centres. Careful electrolyte management, seizure surveillance, and resources for multisystem support remain essential. Limitations include retrospective design, small sample size, single-centre setting, and absence of a non-cooled comparator and long-term neurodevelopmental follow-up.
Keywords: Therapeutic hypothermia; Hypoxic-ischemic encephalopathy; Neonatal complications; Electrolyte imbalance