JEANIE CHEONG NEONATOLOGIST ROYAL WOMEN’S HOSPITAL, MELBOURNE, AUSTRALIA “Keeping cool”: improving perinatal mortality (and outcomes of survivors)

Outcomes at 18 months Outcomes at 6-7 years Meta-analysis 10 studies Edwards BMJ 2010 NICHD Shankaran NEJM 2012 RR (NNT)RR Death0.78 (14)0.66 Death or severe disability0.81 (9)0.72 Severe disability in survivors 0.71 (9)0.83 Hypothermia in HIE Only therapeutic intervention that improves outcome in HIE

Education  Prompt recognition of eligibility  Early commencement of cooling  Cooling in transport Access to equipment  aEEG  Cooling devices (Ice packs!! if desperate) Ongoing support  Clear support network from tertiary neonatal units How do we achieve this?

Neonatal resuscitation Early detection of maternal complications that potentially result in asphyxia-related outcome Other aspects to consider