Therapeutic Hypothermia in Asphyxiated Neonates: Experience from Neonatal Intensive Care Unit of University Hospital of Marrakech

Maoulainine, F. M. R.; Elbaz, Meyer; Elfaiq, S.; Boufrioua, G.; Elalouani, F. Z.; Barkane, M.; Slitine, Nadia El Idrissi

doi:10.1155/2017/3674140

Cited by 8 publications

(8 citation statements)

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“…Major shortcomings were identified in the representativeness of the data with only three papers scoring a star in this question. [47][48][49] Reports about neonatal mortality and developmental outcomes had better scores for case ascertainment than those where incidence of intrapartum-related NE was examined. About half of the reports had issues with incomplete follow-up, which might further bias the results.…”

Section: Bias Evaluation Of the Included Studiesmentioning

confidence: 99%

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

et al. 2022

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AimTo examine the incidence of intrapartum-related neonatal encephalopathy, and neonatal mortality and neurodevelopmental outcomes associated with it in low-income and middle-income countries.MethodsReports were included when neonatal encephalopathy diagnosed clinically within 24 hours of birth in term or near-term infants born after intrapartum hypoxia-ischaemia defined as any of the following: (1) pH≤7.1 or base excess ≤−12 or lactate ≥6, (2) Apgar score ≤5 at 5 or 10 min, (3) continuing resuscitation at 5 or 10 min or (4) no cry from baby at 5 or 10 min. Peer-reviewed articles were searched from Ovid MEDLINE, Cochrane, Web of Science and WHO Global Index Medicus with date limits 1 November 2009 to 17 November 2021. Risk of bias was assessed using modified Newcastle Ottawa Scale. Inverse variance of heterogenicity was used for meta-analyses.ResultsThere were 53 reports from 51 studies presenting data on 4181 children with intrapartum-related neonatal encephalopathy included in the review. Only five studies had data on incidence, which ranged from 1.5 to 20.3 per 1000 live births. Neonatal mortality was examined in 45 studies and in total 636 of the 3307 (19.2%) infants died. Combined outcome of death or moderate to severe neurodevelopmental disability was reported in 19 studies and occurred in 712 out of 1595 children (44.6%) with follow-up 1 to 3.5 years.ConclusionThough there has been progress in some regions, incidence, case mortality and morbidity in intrapartum-related neonatal encephalopathy has been static in the last 10 years.PROSPERO registration numberCRD42020177928.

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Section: Bias Evaluation Of the Included Studiesmentioning

confidence: 99%

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

et al. 2022

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“…Despite management in a Level 2 nursery with access to whole-body cooling machines, cranial ultrasound, amplitude electro-encephalogram (aEEG) monitoring, competency of treatment and personnel with expertise in managing patients with TH, our findings are similar to those of a study in Uganda where patients were followed up for at least 2 years and were managed outside a Level 3 nursery. The GMDS was also used as one of the developmental assessment tools [14]. Cooling infants at Level 2 has some limitations as monitoring is not as intense as in a Level 3 nursery because of the high nurse:patient ratios.…”

Section: Discussionmentioning

confidence: 99%

“…Studies reporting outcome at 18-24 months suggest that neonates with HIE managed with TH outside the NICU might have a severe outcome and so its use outside these settings is still experimental [14,15]. This study sought to determine the long-term (12 and 18-24 months) outcome in neonates with HIE managed with TH in a setting where their care was offered in a high-care unit, i.e.…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental outcome in neonates with hypoxic-ischaemic encephalopathy managed with therapeutic hypothermia in a tertiary-level public hospital outside an intensive care unit setting

Mbatha

Nakwa

Thandrayen

et al. 2021

Paediatrics and International Child Health

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Background: Management of hypoxic-ischaemic encephalopathy (HIE) by therapeutic hypothermia (TH) is a major challenge in low-and middle-income countries (LMIC) because of the limited resources. Clinicians in LMIC offer this intervention outside neonatal intensive care units (NICU). The effect of this practice on neurodevelopmental outcome is not well known. Aim: To determine neurodevelopmental outcome in neonates with HIE managed with TH outside NICU settings. Methods: : This was a retrospective descriptive study of neonates with HIE managed with TH and followed up for neurodevelopmental assessment at 12 and 18-24 months postnatal age. Patients were reviewed over a 24-month period. Outcome at 12 and 18-24 months was compared. Results: Of 178 neonates with HIE attending the clinic, there was information on TH for 155 (87.1%), 113 of whom (72.9%) received TH. HIE was moderate in 88% and severe in 10%. Twenty-seven (23.9%) and 16 (14.1%) were assessed at one time-point at 12 or 18-24 months, respectively, 40 (35.3%) at both time-points, and 30 (26.6%) were not assessed. At 18-24 months, 32% had moderate-to-severe disability compared with 6% at 12 months, with the sensitivity and specificity of assessment at 12 months being 50% and 100%, respectively. The disability attrition rate at 18-24 months was 50%. Conclusions:The relatively low prevalence of disability (32%) at 18-24 months suggests that use of TH in a Level 2 nursery is feasible and possibly beneficial. More studies are needed to confirm these findings

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“…Another web-based survey involving 288 paediatricians and neonatologists in South Africa reported that 76% of the respondents firmly believed therapeutic hypothermia would be beneficial and 46% had been already cooling encephalopathic neonates in their units [24]. Wide implementation of therapeutic hypothermia across neonatal units in Morocco was suggested based on the outcome data of a prospective study involving just 32 asphyxiated neonates in a tertiary hospital in Marakkech [25].…”

Section: Current Practice Of Therapeutic Hypothermia In India and Other Lmicmentioning

confidence: 99%

Rise and Fall of Therapeutic Hypothermia in Low-Resource Settings: Lessons from the HELIX Trial

et al. 2021

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In the past decade, therapeutic hypothermia using a variety of low-cost devices has been widely implemented in India and other low-and middle-income countries (LMIC) without adequate evidence of either safety or efficacy. The recently reported data from the world’s largest cooling trial (HELIX - hypothermia for encephalopathy in low- and middle-income countries) in LMIC provides definitive evidence of harm of cooling therapy with increase in mortality (number to harm 9) and lack of neuroprotection. Although the HELIX participating centers were highly selected tertiary neonatal intensive care units in South Asia with facilities for invasive ventilation, cardiovascular support, and 3 Tesla magnetic resonance imaging (MRI), and the trial used state-of-the-art automated servo-controlled cooling devices, a therapy that is harmful under such optimal conditions cannot be safe in low-resource settings that cannot even afford servo-controlled cooling devices.The HELIX trial has set a new benchmark for conducting high quality randomized controlled trials in terms of research governance, consent, ethics, follow-up rates, and involvement of parents. The standard care for neonatal encephalopathy in LMIC should remain normothermia, with close attention to prevention of hyperthermia. There is no role for therapeutic hypothermia in LMIC as the efficacy of hypothermia is dependent on the population, and not merely on the level of neonatal intensive care facilities. Future research should explore timings and origins of brain injury and prevention of brain injury in LMIC, with a strong emphasis on academic research capacity building and patient and public engagement.

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Therapeutic Hypothermia in Asphyxiated Neonates: Experience from Neonatal Intensive Care Unit of University Hospital of Marrakech

Cited by 8 publications

References 43 publications

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

Neurodevelopmental outcome in neonates with hypoxic-ischaemic encephalopathy managed with therapeutic hypothermia in a tertiary-level public hospital outside an intensive care unit setting

Rise and Fall of Therapeutic Hypothermia in Low-Resource Settings: Lessons from the HELIX Trial

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