Therapeutic hypothermia : a “cool” intervention for reducing mortality in newborn infants with hypoxic-ischaemic encephalopathy

Abstract

Background: Therapeutic Hypothermia (TH) has been suggested as a neuroprotective intervention of choice for newborns with Hypoxic-Ischaemic Encephalopathy (HIE) by major resuscitation societies due to the overwhelming consequences of HIE. TH was introduced locally recently and thus its utility to the local setting has to be investigated so as to provide suggestions for successful implementation. Consequently, the research question "Does Therapeutic Hypothermia (Intervention) reduce mortality (Outcome) in newborn infants of at least 35-week gestation with Hypoxic-Ischaemic Encephalopathy (Population/Problem)?” was set. Methods: The literature search, aimed at retrieving both published and unpublished literature, was carried out using the following databases: University of Malta e-library Hybrid Discovery (HyDi), EBSCOhost, PubMed, TRIP database and OpenGrey. The inclusion and exclusion criteria led by the PICO question guided the selection of articles. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework was used to enhance the search validity and reliability. The search yielded a total of nine meta-analyses eligible for critical appraisal. The Critical Appraisal Skills Programme (CASP) tool was used for critical appraisal of these articles, while guidelines set by Polit and Beck (2012) helped the critique of the ethical issues. Results: The overall findings favoured the application of TH on reducing mortality. However, some methodological flaws, in particular, lack of large samples in some studies used for the meta-analyses could not give definite conclusion of cooling on long-term effects, the efficacy of the methods of cooling, the degree of cooling, and the effects of TH according to the degree of severity. Recommendations and conclusion: Unless new evidence is found, TH should continue as it reduces mortality in newborns of at least 35-week gestation with HIE. This thus warrants further research given that it is within ethical parameters. It was recommended that directly comparing the methods of cooling, long-term follow-up studies and the setting up of cooling registers are vital. Additionally, with the start of TH in the local setting, education to health care professionals is crucial for the early detection of HIE, the success of TH and for beneficial long-term effects.