 |
|
Hypothermia to Treat Neonatal Hypoxic Ischemic EncephalopathySystematic Review
Prakesh S. Shah, MD, MSc, FRCPC;
Arne Ohlsson, FRCPC, MSc;
Max Perlman, FRCPC
Arch Pediatr Adolesc Med. 2007;161(10):951-958.
Objectives To systematically review the effectiveness, as determined by survival without moderate to severe neurodevelopmental disability in infancy and childhood, and the safety of hypothermia vs normothermia in neonates with postintrapartum hypoxic-ischemic encephalopathy and to perform subgroup analyses based on severity of encephalopathy (moderate or severe), type of hypothermia (systemic or selective head cooling), and degree of hypothermia (moderate [ 32.0-33.5°C] or mild [ 33.6°C]).
Data Sources MEDLINE, EMBASE, CINAHL (Cumulative Index for Nursing and Allied Health Literature), the Cochrane Library, abstracts of annual meetings of the Pediatric Academic Societies, and bibliographies of identified articles.
Study Selection Randomized and quasi-randomized controlled trials without language restriction were assessed by 2 reviewers independently and discrepancies were resolved by involving a third reviewer. Quality of the trials was assessed on the basis of concealment of allocation, method of randomization, masking of outcome assessment, and completeness of follow-up.
Intervention Systemic or selective head hypothermia compared with normothermia.
Main Outcome Measure Death or moderate to severe neurodevelopmental disability.
Results Eight studies of acceptable quality were included. The combined outcome of death or neurodevelopmental disability in childhood was reduced in infants receiving hypothermia compared with control infants (4 studies including 497 infants; relative risk, 0.76, 95% confidence interval, 0.65-0.88; number needed to treat, 6; 95% confidence interval, 4-14), as were death and moderate to severe neurodevelopmental disability when analyzed separately. Cardiac arrhythmias and thrombocytopenia were more common with hypothermia; however, they were clinically benign.
Conclusions In neonates with postintrapartum asphyxial hypoxic-ischemic encephalopathy, hypothermia is effective in reducing death and moderate to severe neurodevelopmental disability either in combination or separately and is a safe intervention.
Author Affiliations: Departments of Pediatrics, Mount Sinai Hospital (Drs Shah and Ohlsson) and University of Toronto (Drs Shah, Ohlsson, and Perlman), Toronto, Ontario, Canada.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Time to Adopt Cooling for Neonatal Hypoxic-Ischemic Encephalopathy: Response to a Previous Commentary
Perlman and Shah
Pediatrics 2008;121:616-618.
FULL TEXT
Hypothermia: An Evolving Treatment for Neonatal Hypoxic Ischemic Encephalopathy
Gunn et al.
Pediatrics 2008;121:648-649.
FULL TEXT
Hypothermia to Treat Neonatal Hypoxic Ischemic Encephalopathy
Statler
AAP Grand Rounds 2008;19:3-4.
FULL TEXT
|
