Perinatal asphyxia in the delivery room: Initial management and current cooling guidelines

This review will summarize the guidelines for initiating and delivering therapeutic hypothermia for newborns with hypoxic-ischemic encephalopathy and the related new recommendations from the Neonatal Resuscitation Program in the first few hours after birth. The neuroprotective effects of hypothermia (33.0°C-34.0°C), when initiated before 6 hours of age and continued for 72 hours, in reducing death and disability will be summarized. New studies attempting to optimize neuroprotection by providing deeper and longer cooling will be discussed. Potential problems regarding initiating cooling upon transport, as well as cooling in low-resource setting will be reviewed. Therapeutic hypothermia is safe and effective only with strict adherence to published protocols.