Department of Pediatrics, Ovum Woman and Child Specialty Hospital, Banaswadi, Bengaluru 560043, India.
Department of Pediatrics, SDM College of Medical Sciences, Dharwad 580009, India.
J Trop Pediatr. 2022 Feb 3;68(2). doi: 10.1093/tropej/fmac016.
This structured review aimed to discuss the existing literature on therapeutic hypothermia for moderate to severe neonatal encephalopathy exclusively in low- and middle-income countries (LMICs).
Medline, Embase, CINHAL and Cochrane Registry were searched for original papers with therapeutic hypothermia (TH) for treating neonatal encephalopathy in LMIC with no language restrictions. The search identified 1413 papers from 1990 to 31 August 2021.
Twenty-one original papers were included after duplicates removal and full-text screening in the final review. Fourteen randomized control studies and seven non-randomized studies were discussed with various modes of cooling (servo-controlled, phase changing material, traditional methods), complications during cooling, mortality and long-term neurodevelopmental assessment. Although there is sufficient evidence in LMIC favouring cooling for the reduction in mortality and improving the neurodevelopmental outcomes, nonetheless these studies were widely heterogeneous in terms of method of cooling, tools for assessing developmental outcomes, age at assessment and variations in neuroimaging tools and reporting.
Therapeutic hypothermia is beneficial in LMICs with low certainty of evidence in reducing mortality and improving neurodevelopmental outcomes.
本系统评价旨在专门讨论中低收入国家（LMIC）中中等至重度新生儿脑病的治疗性低体温治疗的现有文献。
检索 Medline、Embase、CINHAL 和 Cochrane 注册中心，以获取关于 LMIC 中治疗性低体温（TH）治疗新生儿脑病的原始论文，无语言限制。该检索从 1990 年到 2021 年 8 月 31 日共确定了 1413 篇论文。
在最终综述中，经过去重和全文筛选后，纳入了 21 篇原始论文。讨论了 14 项随机对照研究和 7 项非随机研究，包括各种冷却方式（伺服控制、相变材料、传统方法）、冷却过程中的并发症、死亡率和长期神经发育评估。尽管有足够的证据表明 LMIC 中冷却有利于降低死亡率和改善神经发育结局，但这些研究在冷却方法、发育结局评估工具、评估年龄以及神经影像学工具和报告的差异方面存在很大的异质性。
治疗性低体温在 LMIC 中是有益的，其降低死亡率和改善神经发育结局的证据确定性较低。
