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Cooling in mild neonatal encephalopathy: a systematic review and meta-analysis

Presented at the Neonatal Society 2018 Spring Meeting (programme).

Kariholu U1, Montaldo P1, Lally PJ1, Oliveira V1, Soe A2, Shankaran S3, Thayyil S1

1 Imperial College London, UK
2 Medway NHS Foundation Trust, UK
3 Wayne State University, USA

Background: Therapeutic hypothermia reduces death and neuro-disability after moderate or severe neonatal encephalopathy (NE), and is a standard care therapy for these babies. However, increasingly many NHS hospitals are also offering hypothermia to babies with mild NE1. We examined if cooling therapy improves neurological outcomes after mild NE.

Methods: We included all randomised controlled trials (RCT) comparing selective head or whole-body cooling with normothermia in term or near-term infants with mild NE. Primary outcome was death or moderate or severe disability at ≥ 18 months of age. We used standard Cochrane methodology for literature search (Pubmed: 1995 to 2018), data extraction and analysis, and random effects model for meta-analysis (RevMan version 5.1.4)

Results: We identified 12 RCT of therapeutic hypothermia (5 selective head cooling and 7 whole body cooling). Five of these included babies with mild NE, of which data could be extracted from three (Table 1). All studies used a modified Sarnat stage to define mild NE. Primary outcome was available from 98 babies for metaanalysis (Figure 1).

Figure 1. Effect of cooling on death or moderate or severe neuro disability after mild NE.

Table 1: Details of included and excluded studies (*N=number of babies with mild NE)

Conclusion: Although a substantial proportion of babies with mild NE have long-term adverse neurological outcomes, the current evidence is insufficient to recommend routine cooling therapy for these babies. Adequately powered clinical trials are required to assess the risk–benefits of therapeutic hypothermia in mild NE.

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