Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: Feasibility, Risks, and Long-Term Outcomes-A...

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Neurology

Background:

• Sudden unexpected postnatal collapse (SUPC) is a rare, severe event in neonates.
• Therapeutic hypothermia is being explored for SUPC due to similarities with hypoxic-ischemic encephalopathy.
• Evidence for therapeutic hypothermia's effectiveness in SUPC is limited.

Purpose of the Study:

• To systematically review and synthesize evidence on therapeutic hypothermia for SUPC.
• To assess the feasibility, outcomes, and limitations of therapeutic hypothermia in neonates with SUPC.

Main Methods:

• Systematic search of major biomedical databases up to February 2025.
• Inclusion of studies on term/near-term infants with SUPC treated with therapeutic hypothermia.
• Data extraction on demographics, collapse details, hypothermia protocols, and clinical outcomes.

Main Results:

• 13 studies involving 70 infants were analyzed.
• Most SUPC events occurred early, associated with primiparity and skin-to-skin contact.
• Therapeutic hypothermia (33-34°C for 72h) showed ~10% mortality, high seizure rates (70-90%), and ~50% normal neurodevelopment in survivors.
• Study quality was low to moderate with substantial risk of bias.

Conclusions:

• Therapeutic hypothermia is feasible in SUPC, with documented survival and favorable outcomes.
• The certainty of evidence is very low, requiring cautious interpretation.
• Preventive strategies and enhanced vigilance are crucial due to identified risk factors.
• Case-by-case consideration in specialized centers, supported by registries, is recommended.