Head cooling for neonatal encephalopathy: the state of the art

The possibility that hypothermia started during or after resuscitation at birth might reduce brain damage and cerebral palsy has tantalized clinicians for a long time. The key insight was that transient severe hypoxia-ischemia can precipitate a complex biochemical cascade leading to delayed neuronal loss. There is now strong experimental and clinical evidence that mild to moderate cooling can interrupt this cascade, and improve the number of infants surviving without disability in the medium term. The key remaining issues are to finding better ways of identifying babies who are most likely to benefit, to define the optimal mode and conditions of hypothermia and to find ways to further improve the effectiveness of treatment.