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Updated: Jun 7, 2025
A Swine Model of Neonatal Asphyxia
Published on: October 11, 2011
Post-Asphyxial Aftercare and Management of Neonates in Low- and Middle-Income Countries: A Systematic Evidence
Oviya Muralidharan1, Sarah Rehman1, Davneet Sihota1
1Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Effective post-resuscitation care for newborns experiencing asphyxia is vital, especially in low- and middle-income countries (LMICs). While magnesium sulfate shows promise, more research is needed on neuroprotection and implementation strategies.
Area of Science:
- Neonatal Medicine
- Perinatal Asphyxia
- Evidence Synthesis
Background:
- Effective post-resuscitation care is critical for neonates suffering from birth asphyxia.
- This review synthesizes interventions for newborns in low- and middle-income countries (LMICs).
Purpose of the Study:
- To provide a comprehensive overview of post-asphyxial aftercare strategies for neonates.
- To synthesize evidence on effective newborn interventions in LMICs.
Main Methods:
- Conducted de novo reviews and updated existing reviews through systematic searches.
- Reanalyzed studies from LMICs, including 61 trials with 5,046 term infants post-asphyxia.
- Evaluated whole-body cooling and pharmacological neuroprotection therapies.
Main Results:
- Limited LMIC data exists for fluid restriction, antiseizure medications, and developmental interventions.
- Whole-body cooling efficacy varied by care center and device in LMICs.
- Magnesium sulfate therapy (60% of trials) significantly improved short-term neonatal mortality and morbidities.
Conclusions:
- Trial sample sizes were small, with low to moderate evidence certainty.
- Limited evidence exists on long-term survival and neurodevelopmental outcomes.
- Further research on neuroprotective therapies and implementation in low-resource settings is crucial, alongside a focus on prevention through improved antenatal and obstetric care.
Introduction:
Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs).
Methods:
Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews.
Results:
Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities.
Conclusion:
The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift toward prevention, and strategies that emphasize improving antenatal and obstetric care.
Introduction:
Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs).
Methods:
Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews.
Results:
Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities.
Conclusion:
The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift toward prevention, and strategies that emphasize improving antenatal and obstetric care.
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