低收入和中等收入国家的治疗性低温症:系统性审查和元分析
Henry C Lee1, Daniela Costa-Nobre2, Anup C Katheria3
1University of California San Diego, La Jolla, CA, United States of America.
The Journal of pediatrics
|August 24, 2025
概括
在低收入和中等收入国家 (LMICs) 中,治疗性低温 (TH) 可能有利于低氧性缺血性脑病 (HIE) 的婴儿. 虽然TH不能完全减少死亡或神经发育障碍,但可能会降低37周或之后出生的婴儿的障碍.
科学领域:
- 新生儿医学
- 儿童神经病学
- 全球健康
背景情况:
- 低毒性缺血性脑病 (HIE) 是新生儿死亡和长期残疾的主要原因.
- 治疗性低温 (TH) 是高收入国家的标准治疗方法.
- 在低收入和中等收入国家 (LMICs) 有有限的TH有效性数据.
研究的目的:
- 在LMIC中评估治疗性低温 (TH) 对中度至重度HIE的疗效和安全性.
- 在资源有限的环境中对TH进行随机对照试验 (RCT) 的综合证据.
主要方法:
- 进行了RCT的系统审查和元分析.
- 这些搜索包括Medline,Embase和CENTRAL,截至2024年9月19日.
- 使用GRADE方法提取和分析了死亡或神经发育障碍 (NDI) 和二次结果的数据.
主要成果:
- 包括804个记录的18个RCT,其中12个专注于预产婴儿.
- 对于死亡或中度至重度的NDI,TH没有显示出统计学上显著的益处或危害 (RR 0. 63;95% CI 0. 38-1. 04;中度确定性).
- 在接受TH治疗的婴儿中,观察到18-24个月的NDI可能下降 (RR0. 51; 95% CI 0. 35- 0. 76; 低确定性).
结论:
- 在LMICs中,TH可能为37周妊娠年龄或之后出生的婴儿提供NDI等二次结果的好处.
- 这些发现适用于已建立协议,重症监护能力和随访能力的医院.
- 可能需要进一步的研究来确认LMIC中TH协议的好处和优化.
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