Efficacy and Prognosis of Hyperbaric Oxygen as Adjuvant Therapy for Neonatal Hypoxic-Ischemic Encephalopathy: A Meta-Analysis Study

Abstract

BackgroundPreclinical and clinical evidence suggests that hyperbaric oxygen therapy (HBOT) may benefit newborns. The effectiveness of HBOT for neonatal hypoxic-ischemic encephalopathy (HIE) remains controversial. We conducted a meta-analysis to evaluate the efficacy and prognosis of HBOT in neonates with HIE.MethodsA systematic search of eight databases was performed for available articles published between January 1, 2015, and September 30, 2020, to identify randomized controlled clinical trials (RCTs) on HBOT for neonatal HIE. Methodological quality assessment was performed by applying the simple procedure detailed by the Cochrane collaboration. Afterward, quality assessment and data analysis were performed using Revman 5.3 software. STATA 15 software was used to detect publication bias as well as for sensitivity analysis.ResultsA total of 46 clinical RCTs were selected for the study and included 4,199 patients with neonatal HIE. The results indicated that HBOT significantly improved the total efficiency (TEF) of treatment for neonatal HIE patients [odds ratio (OR) = 4.61, 95% confidence interval (CI) (3.70, 5.75), P < 0.00001] and reduced the risk of sequelae (OR = 0.23, 95% CI (0.16, 0.33), P < 0.00001) and the neonatal behavioral neurological assessment (NBNA) scores [mean difference (MD) = 4.51, 95%CI (3.83,5.19, P < 0.00001)].ConclusionIn light of the effectiveness of HBOT neonatal HIE, this meta-analysis suggested that HBOT can be a potential therapy for the treatment of neonatal HIE. Due to the heterogeneity of studies protocol and patient selection being only from China, more research is needed before this therapy can be widely implemented in the clinic.Protocol RegistrationPROSPERO (ID: CRD42020210639). Available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020210639.

Hyperbaric oxygen therapy for the treatment of hypoxic/ischemic injury upon perinatal asphyxia—are we there yet?

“…Unfortunately, similar reports regarding experimental birth asphyxia, including clinical trials, are scarce. Available evidence indicates that HBOT applied within a short window after the HI reduces brain damage in newborns ( 16 , 17 , 31 , 38 , 89 , 100 ).…”

“…In the clinical studies described, in which HBOT was used, clinical improvement in the condition of newborns suffering from HI was assessed using multiple methods, such as ECG and transcutaneous oxygen monitoring during HBO session, outcome indicators such as total efficiency (clinical symptoms, signs, and craniocerebral computed tomography), neuronal sequelae, and the NABA score ( 89 , 98 ). The accumulated results of these studies indicate that the benefits of HBOT are obvious.…”

“…The use of monosialogangliosides as adjuvant treatment had also beneficial effects in the improvement of neurological outcomes ( 88 ). Interestingly, a meta-analysis performed by Gong and coworkers on using HBOT in clinical practice as adjuvant therapy for neonatal HIE mentioned 26 successful cases of combining HBOT with gangliosides ( 89 ).…”

“…The information presented in this review indicates that, although the use of HBOT in China is still controversial, this treatment reduced mortality and neurological sequelae in term neonates with HIE. Fifteen years later, Gong and coworkers published a systematic meta-analysis analyzing the use of HBOT as adjuvant therapy for neonatal HIE ( 89 ). They analyzed 46 selected randomized controlled clinical trials, including 4,199 patients with neonatal HIE.…”

Research advances in the role of endogenous neurogenesis on neonatal hypoxic-ischemic brain damage

“…This technique restores the blood-brain barrier via cerebral vasoconstriction, decreasing cerebral blood flow and reducing cerebral hematoma, and simultaneously increasing oxygen supply to ischemic tissues ( 74 ). A meta-analysis study ( 75 ) pointed out that Hyperbaric oxygen therapy significantly improved the total efficiency of treatment for neonatal HIE patients and reduced the risk of sequelae, however, the underlying mechanism is not clear. One study ( 76 ) showed that the likelihood of neurological dysfunctions is lower in a HIBD neonatal rat model undergoing hyperbaric oxygen treatment, compared with controls, suggesting that this therapy may improve prognosis via neuroprotective effects.…”