Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data
A D Edwards,Peter Brocklehurst,Alistair J. Gunn,Henry L. Halliday,Edmund Juszczak,Malcolm I. Levene,Malcolm I. Levene,Brenda Strohm,Marianne Thoresen,Andrew Whitelaw,Denis Azzopardi +10 more
TLDR
In infants with hypoxic-ischaemic encephalopathy, moderate hypothermia is associated with a consistent reduction in death and neurological impairment at 18 months, and this effect was significantly reduced when assessed all 10 trials.Abstract:
Objective To determine whether moderate hypothermia after hypoxic-ischaemic encephalopathy in neonates improves survival and neurological outcome at 18 months of age. Design A meta-analysis was performed using a fixed effect model. Risk ratios, risk difference, and number needed to treat, plus 95% confidence intervals, were measured. Data sources Studies were identified from the Cochrane central register of controlled trials, the Oxford database of perinatal trials, PubMed, previous reviews, and abstracts. Review methods Reports that compared whole body cooling or selective head cooling with normal care in neonates with hypoxic-ischaemic encephalopathy and that included data on death or disability and on specific neurological outcomes of interest to patients and clinicians were selected. Results We found three trials, encompassing 767 infants, that included information on death and major neurodevelopmental disability after at least 18 months’ follow-up. We also identified seven other trials with mortality information but no appropriate neurodevelopmental data. Therapeutic hypothermia significantly reduced the combined rate of death and severe disability in the three trials with 18 month outcomes (risk ratio 0.81, 95% confidence interval 0.71 to 0.93, P=0.002; risk difference −0.11, 95% CI −0.18 to −0.04), with a number needed to treat of nine (95% CI 5 to 25). Hypothermia increased survival with normal neurological function (risk ratio 1.53, 95% CI 1.22 to 1.93, P Conclusions In infants with hypoxic-ischaemic encephalopathy, moderate hypothermia is associated with a consistent reduction in death and neurological impairment at 18 months.read more
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Douglas G. Altman,J M Bland +1 more
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Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy.
Seetha Shankaran,Abbot R. Laptook,Richard A. Ehrenkranz,Jon E. Tyson,Scott A. McDonald,Edward F. Donovan,Avroy A. Fanaroff,W. Kenneth Poole,Linda L. Wright,Rosemary D. Higgins,Neil N. Finer,Waldemar A. Carlo,Shahnaz Duara,William Oh,C. Michael Cotten,David K. Stevenson,Barbara J. Stoll,James A. Lemons,Ronnie Guillet,Alan H. Jobe +19 more
TL;DR: Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic–ischemic encephalopathy and there was no increase in major disability among survivors.
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Cooling for newborns with hypoxic ischaemic encephalopathy.
TL;DR: Although two small randomised controlled trials demonstrated neither evidence of benefit or harm, current evidence is inadequate to assess either safety or efficacy of therapeutic hypothermia in newborn infants with hypoxic ischaemic encephalopathy.
Journal ArticleDOI
Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial
Peter D. Gluckman,John S. Wyatt,Denis Azzopardi,Roberta A. Ballard,A. David Edwards,Donna M. Ferriero,Richard A. Polin,Charlene M.T. Robertson,Marianne Thoresen,Andrew Whitelaw,Alistair J. Gunn +10 more
TL;DR: Induced head cooling is not protective in a mixed population of infants with neonatal encephalopathy, but it could safely improve survival without severe neurodevelopmental disability in infants with less severe aEEG changes.
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