Cooling for newborns with hypoxic ischaemic encephalopathy

Area of Science:

• Neonatal Medicine
• Pediatric Neurology
• Critical Care

Background:

• Newborn animal and human pilot studies suggest mild hypothermia post-peripartum hypoxia-ischaemia may reduce neurological sequelae without adverse effects.
• Hypoxic-ischaemic encephalopathy (HIE) is a serious condition in newborns resulting from oxygen deprivation during birth.

Purpose of the Study:

• To evaluate the effectiveness of therapeutic hypothermia in reducing mortality and long-term neurodevelopmental disability in asphyxiated newborn infants.
• To assess clinically significant side effects associated with therapeutic hypothermia.

Main Methods:

• A systematic review and meta-analysis of 11 randomized controlled trials involving 1505 term and late preterm infants with HIE.
• Searches included major databases and were updated in May 2012, adhering to Cochrane Neonatal Review Group standards.
• Data extraction and quality assessment were performed independently by four reviewers; meta-analyses used risk ratios and risk differences.

Main Results:

• Therapeutic hypothermia significantly reduced the combined outcome of mortality or major neurodevelopmental disability by 15% (NNTB=7).
• Cooling also led to significant reductions in mortality (NNTB=11) and neurodevelopmental disability in survivors (NNTB=8).
• Adverse effects observed included increased sinus bradycardia and thrombocytopenia.

Conclusions:

• Therapeutic hypothermia is beneficial for term and late preterm newborns with moderate-to-severe HIE, reducing mortality without increasing disability in survivors.
• The benefits of cooling on survival and neurodevelopment outweigh short-term adverse effects.
• Hypothermia should be initiated within six hours of age for eligible infants; further research is needed to optimize cooling techniques.