Effectiveness of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy outcome:- umbrella review

Abstract

Abstract Background Therapeutic hypothermia is believed to have significant effects to reduce death and disability among neonates with HIE. Despite the evidence are generated in different parts of the world, the utilization of therapeutic hypothermia is limited especially in developing countries where the burden of neonatal asphyxia is dominant. To adopt or defer this interventional technology additional compelled evidences that analyze the clinical effectiveness shall have significant effects. Thus, this umbrella based review assessment aimed to evaluate the clinical effectiveness of therapeutic hypothermia to improve neonatal hypoxic-ischemic encephalopathy outcome. Methods and materials The primary outcome of this rapid umbrella review was neonatal mortality and the secondary outcome was disability at the age of 18 month following therapeutic hypothermia. Boolean terms including AND, OR, and NOT in the PICO term guide were used in searching term development. Data bases with advanced search options were used and; 302, 160, 353, 33, and 169 articles were selected from PubMed, BASE (Bielefeld Academic Search Engine), Google scholar, Cochrane Library and Science Direct data bases respectively. JBI systematic review and meta-analysis review quality appraisal tool was used for the article appraisal. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist was used. Result In this umbrella review and meta-analysis, therapeutic hypothermia was found to reduce the risk of mortality at neonatal periods by18% (RR: 0.817, CI: 0.758, 0.880) with I 2 = 30.76%. The results indicated that studies conducted in low and middle-income countries demonstrated a 21% reduction of mortality (RR = 0.79, 95% CI: 0.73–0.86). The pooled relative risk of disability among individuals with HIE at age 18 and older was 0.65 (95% CI: 0.40–1.07), indicating a potential reduction in risk. Conclusion This umbrella review showed that therapeutic hypothermia is effective to reduce mortality at neonatal period and disability at the age of 18 months. The sub group analysis reviled that therapeutic hypothermia is effective in low and middle income settings. Therefore, the practice gap shall be breached to save neonatal life and enhance later on quality of life.