Therapeutic Hypothermia for Neonatal Encephalopathy in Low- and Middle-Income Countries: A Literature Review

Abstract

Aims 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). Methods 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. Results 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. Conclusion Therapeutic hypothermia is beneficial in LMICs with low certainty of evidence in reducing mortality and improving neurodevelopmental outcomes.

Breaking down barriers: Overcoming bottlenecks in the health- care system for newborns with hypoxic ischemic encephalopathy

“…There is evidence that TH can lower the mortality rate of neonates with HIE [24], [25]. Our ndings indicate that a lack of awareness of guidelines for TH may lead to variation in the early management of HIE, as previously reported [26].…”

Clinical and Neuroimaging Profile of Neonates With Moderate-to-Severe Encephalopathy Treated With Therapeutic Hypothermia

“…9 In LMIC, although the evidence is debatable, recent systematic reviews and meta-analysis have concluded it to be beneficial with low quality of evidence. 9, 10 In public sector hospitals, the uptake and applicability of cooling therapy in India is poor, due to the lack of intensive care and transport facilities to initiate and administer the treatment within the therapeutic window after birth. 11 When facilities are inadequate or suboptimal, providing cooling therapy could be hazardous.…”

Prevalence of hearing impairment in neonatal encephalopathy due to hypoxia-ischemia: a systematic review and meta-analysis

“…10 The other recent systematic reviews did not report on hearing outcomes. [11][12][13] While managing an infant with HIE, an important question that clinicians and parents face is "what are the chances of developing hearing impairment if the infant were to survive?". To answer that question, it is essential to know the prevalence rates of hearing impairment in infants with HIE based on the current literature.…”