Treatment of hypoxic-ischemic encephalopathy in neonates: a systematic review and meta-analysis

Abstract

To investigate the clinical effectiveness of treatment with hypothermia, erythropoietin (EPO), hyperbaric oxygenation (HBO), xenon gas treatment, melatonin for neonates with hypoxic-ischemia encephalopathy (HIE). A comprehensive searching work of related publications was carried out in the Pubmed and CNKI database. Those randomized controlled trials deemed eligible, which made comparisons between the therapies for neonates with HIE and the normal treatment. The continuous and dichotomous data were evaluated by weighted mean difference (WMD) and risk ratio (RR) or Odds Ratio (OR) with 95% confidence interval (CI), respectively. After searching for the interesting publications concerning the therapies, xenon gas and melatonin treatment were out of analysis due to the lack of enough clinical data. Hypothermia treatment made contributions to a notable reduction concerning the incidence of death in neonatal HIE compared with normothermic treatment during the follow-up (OR = 0.66; 95% CI = 0.48, 0.91; p = 0.01); EPO treatment correlated with a great reduction in the incidence of severe brain injury in neonatal HIE compared with placebo treatment. There was no significance between the EPO and placebo groups concerning incidence of death (OR = 0.84; 95% CI = 0.45, 1.56; p = 0.57). Moreover, HBO shortened the time of muscular tension recovery and awareness restoration (MD = -1.67; 95% CI = -2.05, -1.3; p <0.00001). Hypothermia, EPO and HBO were effective in the treatment of neonates with HIE. Whereas, there are still lack of ample clinical data to guarantee the proper handle of their long-term effects.