Evidence map›Paper›PMID 34297336›Full record

ReviewIndian journal of pediatrics2021

Rise and Fall of Therapeutic Hypothermia in Low-Resource Settings: Lessons from the HELIX Trial.

Vaisakh Krishnan, Vijay Kumar, Seetha Shankaran, Sudhin Thayyil

Open access · hybridAbstract readReview
PubMed Publisher
In one paragraph

Review in Indian journal of pediatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 1 pooled it
11.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.

  1. Pooled it
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  5. Status epilepticus in the neonate.BMJ paediatrics open · 2025
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 3 countries.

Vaisakh KrishnanInstitute of Maternal and Child Health, Calicut Medical College, Kozhikode, Kerala, India.
Vijay KumarNeonatal Intensive Care Unit, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Seetha ShankaranNeonatal Perinatal Medicine, Wayne State University, Detroit, MI, USA.
Sudhin ThayyilCentre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College, London, W12 0HS, UK. s.thayyil@imperial.ac.uk.
Imperial College London · GBWayne State University · US

Funding

Department of Health NIHR200144National Institute for Health Research NIHR200144
6 · The paper itself

Abstract

In the past decade, therapeutic hypothermia using a variety of low-cost devices has been widely implemented in India and other low-and middle-income countries (LMIC) without adequate evidence of either safety or efficacy. The recently reported data from the world's largest cooling trial (HELIX - hypothermia for encephalopathy in low- and middle-income countries) in LMIC provides definitive evidence of harm of cooling therapy with increase in mortality (number to harm 9) and lack of neuroprotection. Although the HELIX participating centers were highly selected tertiary neonatal intensive care units in South Asia with facilities for invasive ventilation, cardiovascular support, and 3 Tesla magnetic resonance imaging (MRI), and the trial used state-of-the-art automated servo-controlled cooling devices, a therapy that is harmful under such optimal conditions cannot be safe in low-resource settings that cannot even afford servo-controlled cooling devices.The HELIX trial has set a new benchmark for conducting high quality randomized controlled trials in terms of research governance, consent, ethics, follow-up rates, and involvement of parents. The standard care for neonatal encephalopathy in LMIC should remain normothermia, with close attention to prevention of hyperthermia. There is no role for therapeutic hypothermia in LMIC as the efficacy of hypothermia is dependent on the population, and not merely on the level of neonatal intensive care facilities. Future research should explore timings and origins of brain injury and prevention of brain injury in LMIC, with a strong emphasis on academic research capacity building and patient and public engagement.

Indexed as

EncephalopathyHypothermiaLow-and middle-income countriesNewborn

Identifiers

PMID34297336
OpenAlexW3183248575

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.