There is compelling evidence from randomized controlled trials that therapeutic hypothermia for full- or near-term neonates with moderate to severe neonatal encephalopathy (NE) significantly improves survival without a disability.1 It is interesting to reflect that therapeutic hypothermia was being tested in a variety of ways well before the first large randomized trials, often using immersion in ice-cold water during resuscitation, followed by gradual, spontaneous rewarming.2 The subsequent 20 years of translational studies provided a strong evidence base to enable successful phase 3 clinical trials to be performed and for the therapy to be officially adopted as the standard of care.3 Follow-up of these trials is available to mid-childhood. Here, we report a case of NE with over 53 years of follow-up after treatment with therapeutic hypothermia by immersion. To the best of our knowledge, this is the longest follow-up recorded in the history of the treatment of NE.

In 1967, I was treated with hypothermia by immersion in ice-cold water as part of a local study, and then developed subcutaneous fat necrosis.4 Both myself and one other case were reported by the neonatal team who looked after me to have had otherwise favorable short-term outcomes, but on the basis of this complication, these early studies of hypothermia were stopped. I was born weighing 3970 g at full term after an uncomplicated pregnancy, labor, and delivery. As reported,4 at 1 min after birth I became apneic and did not respond to resuscitation. After 5 min, I was placed in an ice-water bath. My breathing was reported to recover after 28 min of hypothermia. At 45 min of life, my capillary pH was 6.9, but recovered steadily, and I was discharged at day 3. Subcutaneous fat necrosis developed between 2 and 4 weeks of age. The calcium deposits were largely cleared by 6 months. My serum calcium remained normal, and my weight gain and development were considered appropriate at that age, but no further follow-up was reported.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account
Continue with Google
Continue with ORCiD