Unravelling mysteries in the origins of neonatal brain injury in the low resource setting

Dr Vaisakh Krishnan PA MD, DNB (Paediatrics)

The results of the largest cooling trial till date – the HELIX trial was quite shocking for all the practising neonatologists across the low- and middle-income countries. The trial results provided robust evidence that therapeutic hypothermia caused more harm than benefit to the neonates with hypoxic brain injury in the resource-poor nations. The clinician’s armamentarium to tackle this sinister diagnosis is hence again restricted to basic supportive care.

So why did hypothermia – a well-established intervention in the west claimed to have prevented thousands of deaths and neuro disability miserably fail in the developing world? This haunting question led me to take up my doctoral thesis in trying to decipher the origin and timings of brain injury with the help of advanced magnetic biomarkers and electroencephalograph in a large prospective cohort of neonates. I have completed undergraduate (MBBS) and post-graduate medical training (MD) in one of the busiest maternity hospitals in south India, the Institute of Maternal and Child Health, Kozhikode. In September 2020, I was appointed to a joint Neonatal Neurology Fellowship program between Imperial College London and Kozhikode Medical College, Kerala, India, as a part of an NIHR program grant to Professor Sudhin Thayyil. It is during this time that I got inspired to pursue a PhD and kickstart an academic career. It is rare in this part of the world for clinicians to take up an academic route due to a lack of funding opportunities and guidance. I consider this as a wonderful opportunity to gain knowledge in research and hope to contribute to the understanding of the occurrence of brain injury in these settings as the incidence is considerably higher in this part of the world and a considerable amount of babies suffer the mortality and morbidity associated with neonatal encephalopathy.