Document Detail


Cooling for newborns with hypoxic ischaemic encephalopathy.
MedLine Citation:
PMID:  23440789     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Newborn animal studies and pilot studies in humans suggest that mild hypothermia following peripartum hypoxia-ischaemia in newborn infants may reduce neurological sequelae without adverse effects.
OBJECTIVES: To determine the effect of therapeutic hypothermia in encephalopathic asphyxiated newborn infants on mortality, long-term neurodevelopmental disability and clinically important side effects.
SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group as outlined in The Cochrane Library (Issue 2, 2007). Randomised controlled trials evaluating therapeutic hypothermia in term and late preterm newborns with hypoxic ischaemic encephalopathy were identified by searching the Oxford Database of Perinatal Trials, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2007, Issue 2), MEDLINE (1966 to June 2007), previous reviews including cross-references, abstracts, conferences, symposia proceedings, expert informants and journal handsearching. We updated this search in May 2012.
SELECTION CRITERIA: We included randomised controlled trials comparing the use of therapeutic hypothermia with standard care in encephalopathic term or late preterm infants with evidence of peripartum asphyxia and without recognisable major congenital anomalies. The primary outcome measure was death or long-term major neurodevelopmental disability. Other outcomes included adverse effects of cooling and 'early' indicators of neurodevelopmental outcome.
DATA COLLECTION AND ANALYSIS: Four review authors independently selected, assessed the quality of and extracted data from the included studies. Study authors were contacted for further information. Meta-analyses were performed using risk ratios (RR) and risk differences (RD) for dichotomous data, and weighted mean difference for continuous data with 95% confidence intervals (CI).
MAIN RESULTS: We included 11 randomised controlled trials in this updated review, comprising 1505 term and late preterm infants with moderate/severe encephalopathy and evidence of intrapartum asphyxia. Therapeutic hypothermia resulted in a statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age (typical RR 0.75 (95% CI 0.68 to 0.83); typical RD -0.15, 95% CI -0.20 to -0.10); number needed to treat for an additional beneficial outcome (NNTB) 7 (95% CI 5 to 10) (8 studies, 1344 infants). Cooling also resulted in statistically significant reductions in mortality (typical RR 0.75 (95% CI 0.64 to 0.88), typical RD -0.09 (95% CI -0.13 to -0.04); NNTB 11 (95% CI 8 to 25) (11 studies, 1468 infants) and in neurodevelopmental disability in survivors (typical RR 0.77 (95% CI 0.63 to 0.94), typical RD -0.13 (95% CI -0.19 to -0.07); NNTB 8 (95% CI 5 to 14) (8 studies, 917 infants). Some adverse effects of hypothermia included an increase sinus bradycardia and a significant increase in thrombocytopenia.
AUTHORS' CONCLUSIONS: There is evidence from the 11 randomised controlled trials included in this systematic review (N = 1505 infants) that therapeutic hypothermia is beneficial in term and late preterm newborns with hypoxic ischaemic encephalopathy. Cooling reduces mortality without increasing major disability in survivors. The benefits of cooling on survival and neurodevelopment outweigh the short-term adverse effects. Hypothermia should be instituted in term and late preterm infants with moderate-to-severe hypoxic ischaemic encephalopathy if identified before six hours of age. Further trials to determine the appropriate techniques of cooling, including refinement of patient selection, duration of cooling and method of providing therapeutic hypothermia, will refine our understanding of this intervention.
Authors:
Susan E Jacobs; Marie Berg; Rod Hunt; William O Tarnow-Mordi; Terrie E Inder; Peter G Davis
Related Documents :
4024919 - Breast feeding of low birthweight infants.
1291499 - Breastfeeding and weaning practices in relation to nutritional status of infants.
18264719 - Factors associated with defecation patterns in 0-24-month-old children.
3183869 - Effects of feeding regimen on blood glucose levels and plasma concentrations of pancrea...
10676059 - Breast-feeding, diarrhoea and sanitation as components of infant and child health: a st...
653359 - Postpartum amenorrhea: how is it affected by maternal nutritional status?
20351659 - Aquaporin-4 gene variation and sudden infant death syndrome.
18444089 - Cortical maldevelopment in congenital cytomegalovirus infection transmitted by a woman ...
15077859 - Comfort scale: a reliable and valid method to measure the amount of stress of ventilate...
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-31
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  1     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2013  
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-03-12     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD003311     Citation Subset:  IM    
Affiliation:
Neonatal Services, Royal Women’s Hospital, Parkville, Melbourne, Australia. Sue.Jacobs@thewomens.org.au
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Asphyxia Neonatorum / complications*
Developmental Disabilities / prevention & control*
Humans
Hypothermia, Induced / adverse effects,  methods*
Hypoxia-Ischemia, Brain / mortality,  therapy*
Infant
Infant, Newborn
Infant, Premature
Randomized Controlled Trials as Topic
Term Birth
Comments/Corrections
Update Of:
Cochrane Database Syst Rev. 2007;(4):CD003311   [PMID:  17943788 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Depot versus daily administration of gonadotrophin-releasing hormone agonist protocols for pituitary...
Next Document:  Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery...