This refers to the large multicentric trial conducted in India, and recently published in Indian Pediatrics [1]. I have few concerns related to this paper. To begin with, the ambient temperature in the neonatal intensive care unit (NICU) in any of the centers was not mentioned in the study, which is very important for the Phase changing material (PCM) to work effectively [2]. The time taken to reach the target temperature was longer (120 minutes) but the fluctuation was less (0.39) in this study as compared to other large trials. The mean age of initiation of cooling (2.9 hours) was impressive as average time taken to reach hospital in out-born babies in Indian scenario ranges from 2-5.6 hours [3], and less than 30% of babies reach within 6 hours of life [4]. It would be worth knowing the number of inborn and out-born babies in each center. Three out of 103 babies with mild encephalopathy were cooled when they were not eligible for the intervention.

The discussion of the study mentions that it had only 10% (results showed nearly 19%) of babies with severe encephalopathy as compared to 60% in TOBY trial [5], which is a huge difference as we know that babies with severe insult have multiorgan dysfunction creating doubts about authors’ claims of PCM to be safe and feasible. Lastly, the study was partly funded by a manufacturer of PCM, which could have possibly, but not necessarily, influenced the interpretation of study results. It also raises the question when the results mention that PCM is comparable to servo-controlled equipment in maintaining target temperature, when this study has not directly compared to this intervention with servo-controlled devices.

1. Thomas N, Abiramalatha T, Bhat V, Varanattu M, Rao S, Wazir S, et al. Phase changing material for therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy – a multi-centric study. Indian Pediatr. 2018;55:201-6.

2. Thayyil S, Shankaran S, Wade A, Cowan FM, Ayer M, Satheesan K, et al. Whole-body cooling in neonatal encephalopathy using phase changing material. Arch Dis Child Fetal Neonatal Ed. 2013;98:F280-1.

3. Narang M, Kaushik JS, Sharma AK, Faridi MM.　Predictors of mortality among the neonates transported to referral centre in Delhi,　India. Indian J Public Health.　2013;57: 100-10.

4. Rathod D, Adhisivam B, Vishnu Bhat B. Transport of sick neonates to a tertiary care hospital, south India: Condition at arrival and outcome. Trop Doctor. 2015;45:96.