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Hyperbaric oxygen in children with cerebral palsy: A systematic review of effectiveness and safety
Justine Laureau1, Christelle Pons2,3,4, Guy Letellier5
1Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, Nantes, France.
Insights
Hyperbaric oxygen therapy (HBOT) does not improve motor or cognitive functions in children with cerebral palsy (CP). HBOT is linked to more adverse events compared to pressurized air therapy.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) encompasses a group of permanent disorders of the development of movement, associated with non-progressive abnormalities of the developing brain.
- Impairments in CP can affect motor function, cognition, sensation, and communication, significantly impacting a child's quality of life.
- Hyperbaric oxygen therapy (HBOT) has been explored as a potential intervention for various neurological conditions, including CP.
Purpose of the Study:
- To evaluate the current evidence on the efficacy of HBOT for children with CP.
- To assess the safety profile of HBOT in this pediatric population.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Cochrane Library, Google Scholar, UHMS).
- Methodological quality of identified studies was assessed using established tools (PEDro scale, modified Downs and Black).
- Meta-analysis was performed for relevant randomized controlled trials (RCTs).
Main Results:
- Five RCTs with high-level evidence were identified, alongside seven lower-quality observational studies.
- All RCTs utilized 100% oxygen at 1.5-1.75 ATA, with controls including pressurized air or physical therapy.
- No significant improvements in motor or cognitive functions were observed in the HBOT groups compared to controls in most RCTs.
- Adverse events, primarily mild middle ear barotrauma, occurred in up to 50% of children.
Conclusions:
- High-level evidence indicates HBOT is ineffective for improving motor and cognitive functions in children with CP.
- Moderate evidence suggests HBOT is associated with an increased rate of adverse events compared to pressurized air therapy.
Purpose:
To report current evidence regarding the effectiveness of hyperbaric oxygen therapy (HBOT) on the impairments presented by children with cerebral palsy (CP), and its safety.
Materials And Methods:
PUBMED, The Cochrane Library, Google Scholar, and the Undersea and Hyperbaric Medical Society database were searched by two reviewers. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the modified Downs and Black (m-DB) evaluation tool for non RCTs. A meta-analysis was performed where applicable for RCTs.
Results:
Five RCTs were identified. Four had a high level of evidence. Seven other studies were observational studies of low quality. All RCTs used 100% O2, 1.5 to 1.75 ATA, as the treatment intervention. Pressurized air was the control intervention in 3 RCTs, and physical therapy in 2. In all but one RCTs, similar improvements were observed regarding motor and/or cognitive functions, in the HBOT and control groups. Adverse events were mostly of mild severity, the most common being middle ear barotrauma (up to 50% of children).
Conclusion:
There is high-level evidence that HBOT is ineffective in improving motor and cognitive functions, in children with CP. There is moderate-level evidence that HBOT is associated with a higher rate of adverse events than pressurized air in children.
