Department of Public Health and Primary Health Care, the University of Oxford, Ethox Centre, UK.
Indian Pediatr. 2010 May;47(5):387-93. doi: 10.1007/s13312-010-0074-6.
Trials in developed countries have shown that therapeutic hypothermia reduces the risk of death or severe disability in infants with neonatal encephalopathy. Cooling has been adopted as a standard of care in some parts of the world. Some Indian neonatal units have considered or even embarked upon cooling encephalopathic term newborn infants. In this article we discuss some of the potential ethical questions that should be considered before introducing therapeutic hypothermia in an Indian setting. Evidence from previous trials may not be relevant given significant differences in the epidemiology of neonatal encephalopathy in countries like India. There is a possibility that hypothermia would be ineffective or harmful. The most appropriate way to answer these concerns would be to perform a large randomized controlled trial of cooling in India. However, such trials will also raise potential ethical challenges. Cooling may also affect decisions about treatment withdrawal, and may create uncertainty about prognosis. It may exacerbate ethical problems relating to lack of neonatal intensive care bed space.
发达国家的试验表明，治疗性低温可降低患有新生儿脑病的婴儿死亡或严重残疾的风险。在世界上的一些地区，降温已被采纳为标准的护理方法。一些印度新生儿病房已经考虑甚至开始对患有脑病的足月新生儿进行降温。在本文中，我们讨论了在印度引入治疗性低温之前应考虑的一些潜在的伦理问题。由于像印度这样的国家新生儿脑病的流行病学存在显著差异，之前试验的证据可能并不相关。低温可能无效或有害。回答这些问题的最合适方法是在印度进行大规模随机对照降温试验。然而，此类试验也将带来潜在的伦理挑战。降温也可能影响治疗撤退的决定，并可能对预后产生不确定性。它可能会加剧与缺乏新生儿重症监护床位有关的伦理问题。
