Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.

<h4>Unlabelled</h4>Although selective or whole body cooling combined with optimal intensive care improves outcomes following neonatal encephalopathy in high-income countries, the safety and efficacy of cooling in low-and middle-income countries is not known.<h4>Objective</h4>...

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Autores principales:	Shreela S Pauliah, Seetha Shankaran, Angie Wade, Ernest B Cady, Sudhin Thayyil
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2d78a89aea1845edbd0c81f0fbf0ef37
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spelling	oai:doaj.org-article:2d78a89aea1845edbd0c81f0fbf0ef372021-11-18T07:52:57ZTherapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0058834https://doaj.org/article/2d78a89aea1845edbd0c81f0fbf0ef372013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23527034/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Unlabelled</h4>Although selective or whole body cooling combined with optimal intensive care improves outcomes following neonatal encephalopathy in high-income countries, the safety and efficacy of cooling in low-and middle-income countries is not known.<h4>Objective</h4>We performed a systematic review and meta-analysis of all published randomised or quasi-randomised controlled trials of cooling therapy for neonatal encephalopathy in low-and middle-income countries.<h4>Results</h4>Seven trials, comprising a total of 567 infants were included in the meta-analysis. Most study infants had mild (15%) or moderate encephalopathy (48%) and did not receive invasive ventilation (88%). Cooling devices included water-circulating cooling caps, frozen gel packs, ice, water bottles, and phase-changing material. No statistically significant reduction in neonatal mortality was seen with cooling (risk ratio: 0.74, 95% confidence intervals: 0.44 to 1.25). Data on other neonatal morbidities and long-term neurological outcomes were insufficient.<h4>Conclusion</h4>Cooling therapy was not associated with a statistically significant reduction in neonatal mortality in low-and middle-income countries although the confidence intervals were wide and not incompatible with results seen in high-income countries. The apparent lack of treatment effect may be due to the heterogeneity and poor quality of the included studies, inefficiency of the low technology cooling devices, lack of optimal neonatal intensive care, sedation and ventilatory support, overuse of oxygen, or may be due to the intrinsic difference in the population, for example higher rates of perinatal infection, obstructed labor, intrauterine growth retardation and maternal malnutrition. Evaluation of the safety and efficacy of cooling in adequately powered randomised controlled trials is required before cooling is offered in routine clinical practice in low-and middle-income countries.Shreela S PauliahSeetha ShankaranAngie WadeErnest B CadySudhin ThayyilPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e58834 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Shreela S Pauliah Seetha Shankaran Angie Wade Ernest B Cady Sudhin Thayyil Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
description	<h4>Unlabelled</h4>Although selective or whole body cooling combined with optimal intensive care improves outcomes following neonatal encephalopathy in high-income countries, the safety and efficacy of cooling in low-and middle-income countries is not known.<h4>Objective</h4>We performed a systematic review and meta-analysis of all published randomised or quasi-randomised controlled trials of cooling therapy for neonatal encephalopathy in low-and middle-income countries.<h4>Results</h4>Seven trials, comprising a total of 567 infants were included in the meta-analysis. Most study infants had mild (15%) or moderate encephalopathy (48%) and did not receive invasive ventilation (88%). Cooling devices included water-circulating cooling caps, frozen gel packs, ice, water bottles, and phase-changing material. No statistically significant reduction in neonatal mortality was seen with cooling (risk ratio: 0.74, 95% confidence intervals: 0.44 to 1.25). Data on other neonatal morbidities and long-term neurological outcomes were insufficient.<h4>Conclusion</h4>Cooling therapy was not associated with a statistically significant reduction in neonatal mortality in low-and middle-income countries although the confidence intervals were wide and not incompatible with results seen in high-income countries. The apparent lack of treatment effect may be due to the heterogeneity and poor quality of the included studies, inefficiency of the low technology cooling devices, lack of optimal neonatal intensive care, sedation and ventilatory support, overuse of oxygen, or may be due to the intrinsic difference in the population, for example higher rates of perinatal infection, obstructed labor, intrauterine growth retardation and maternal malnutrition. Evaluation of the safety and efficacy of cooling in adequately powered randomised controlled trials is required before cooling is offered in routine clinical practice in low-and middle-income countries.
format	article
author	Shreela S Pauliah Seetha Shankaran Angie Wade Ernest B Cady Sudhin Thayyil
author_facet	Shreela S Pauliah Seetha Shankaran Angie Wade Ernest B Cady Sudhin Thayyil
author_sort	Shreela S Pauliah
title	Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
title_short	Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
title_full	Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
title_fullStr	Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
title_full_unstemmed	Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
title_sort	therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/2d78a89aea1845edbd0c81f0fbf0ef37
work_keys_str_mv	AT shreelaspauliah therapeutichypothermiaforneonatalencephalopathyinlowandmiddleincomecountriesasystematicreviewandmetaanalysis AT seethashankaran therapeutichypothermiaforneonatalencephalopathyinlowandmiddleincomecountriesasystematicreviewandmetaanalysis AT angiewade therapeutichypothermiaforneonatalencephalopathyinlowandmiddleincomecountriesasystematicreviewandmetaanalysis AT ernestbcady therapeutichypothermiaforneonatalencephalopathyinlowandmiddleincomecountriesasystematicreviewandmetaanalysis AT sudhinthayyil therapeutichypothermiaforneonatalencephalopathyinlowandmiddleincomecountriesasystematicreviewandmetaanalysis
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Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis.

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