369 - Therapeutic Hypothermia for Neonatal Encephalopathy in Low and Middle Income Countries – A Systematic Review

Poster Number: 369
Publication Number: 369.132

Roshani Krishne gowda, Shri Dharmasthala College of Medical Sciences and Hospital, muscat, Masqat, Oman; Shivashankar Diggikar, Ovum Woman and Child Speciality Hospital, Bengaluru, Karnataka, India

Background: Therapeutic Hypothermia (TH), has emerged as the standard of care for babies with moderate to severe encephalopathy with comprehensive evidence from high-income countries. On the contrary, the evidence for the same is suboptimal in Low & Middle Income countries (LMIC).

Objective: This systematic review aims to discuss the existing literature on therapeutic hypothermia for moderate to severe neonatal encephalopathy exclusively in Low and Middle Income countries with respect to primary outcomes like death, major neuro-developmental disability and secondary outcomes like seizures, abnormal neuro-imaging, sepsis, bleeding tendencies, necrotising enterocolitis and length of hospitalisation.

Design/Methods: This systematic review was conducted as per Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) reporting guideline. Medline, Embase, CINHAL and cochrane registry were searched for original papers with therapeutic hypothermia (TH) for treating neonatal encephalopathy in Low and Middle Income Countries (LMIC) with no language restrictions. The search identified 1413 papers from 1990 to 2021.

Results: Twenty-one original papers were included after duplicates removal and full-text screening in the final review. Fourteen were randomised controlled trials and seven were non-randomised intervention studies. The studies were discussed after dividing them based on the method of cooling equipment used i.e. servo-controlled, phase changing material and traditional cooling methods. The outcomes discussed were mortality, long term neurodevelopmental outcome and other morbidities. All the included studies were widely heterogeneous in terms of method of cooling used and long-term neurodevelopmental assessments, power calculations, nonetheless the outcomes for mortality and neurodevelopment favoured cooling.Conclusion(s): Therapeutic Hypothermia is beneficial in Low and Middle Income Countries with low certainty of evidence in reducing mortality and improving neurodevelopmental outcome.
Table 1Summary of findings
Figure 1Summary of Risk of Bias (ROB tool from Cochrane Handbook for Systematic Reviews of Intervention for all the domains)