Therapeutic hypothermia for mild neonatal encephalopathy: a systematic review and meta-analysis

Abstract

ObjectivesTo examine if therapeutic hypothermia reduces the composite outcome of death, moderate or severe disability at 18 months or more after mild neonatal encephalopathy (NE).Data sourceMEDLINE, Cochrane database, Scopus and ISI Web of Knowledge databases, using ‘hypoxic ischaemic encephalopathy’, ‘newborn’ and ‘hypothermia’, and ‘clinical trials’ as medical subject headings and terms. Manual search of the reference lists of all eligible articles and major review articles and additional data from the corresponding authors of selected articles.Study selectionRandomised and quasirandomised controlled trials comparing therapeutic hypothermia with usual care.Data extractionSafety and efficacy data extracted independently by two reviewers and analysed.ResultsWe included the data on 117 babies with mild NE inadvertently recruited to five cooling trials (two whole-body cooling and three selective head cooling) of moderate and severe NE, in the meta-analysis. Adverse outcomes occurred in 11/56 (19.6%) of the cooled babies and 12/61 (19.7%) of the usual care babies (risk ratio 1.11 (95% CIs 0.55 to 2.25)).ConclusionsCurrent evidence is insufficient to recommend routine therapeutic hypothermia for babies with mild encephalopathy and significant benefits or harm cannot be excluded.

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

“…There are no RCTs on TH in this population, and data from studies including these neonates showed variable results. A recent systematic review showed that there is insufficient evidence for a beneficial role of TH in babies with mild NE [10].…”

Metabolic Phenotypes of Hypoxic-Ischemic Encephalopathy with Normal vs. Pathologic Magnetic Resonance Imaging Outcomes

“…In addition, this study does not include a healthy control group or newborns with asphyxia or classified as mild HIE (Sarnat 1), as only newborns subjected to hypothermia treatment were included. There is risk of adverse neurodevelopmental outcome of mild HIE newborns, but, up to now, there is no evidence to support cooling in these babies, and therefore we consider that the study of the metabolic fingerprint of those infants in correlation with the clinical outcomes would be of interest [30]. Furthermore, metabolomic coverage could be increased by taking advantage of complementary methods and analytical platforms.…”

Hypothermia as an adjuvant treatment in paediatric refractory or super‐refractory status epilepticus

“…11 The only proven indication of therapeutic hypothermia in paediatric patients is neonatal encephalopathy. 12 Therapeutic hypothermia modalities in children Therapeutic hypothermia requires mechanical ventilation. Careful attention must be given to the induction and maintenance of hypothermia, sedation, indications and modalities of neuromuscular blockade, monitoring (body temperature, electroencephalography [EEG], anaesthetics), and rewarming modalities.…”