Evidence-based Medicine Reviews Of Treatment For Newborns With Hypoxic Ischaemic Encephalopathy

[Background]Neonatal hypoxic-ischemic encephalopathy(HIE) due to the perinatal asphyxia is a major problem of newborn health.Still,prevention and treatment of HIE a main problem we need to due.The treatment for HIE in China need to be criterion through evidence-based methods.[Objective]By means of evidence-based medicine(EBM) to achieve the standardization of treatment for HIE.To determine the effect of treatments for HIE in China,we search literatures from database and evaluate through evidence-based methods,in support of setting a practice guidelines for HIE treatment.[Methods]We summarized the data of randomised controlled trials comparing the use of special treatments with standard care in newborn infants with evidence of peripartum asphyxia.Methodological quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions 4.2.2.Meta-analyses of the data we search were performed by using the Review Manager.[Results]Meta-analyses found the hypothermia groups a significant reduction in death or major neurodevelopmental disability in survivors(RR=0.72,95%CI: 0.63-0.84,P＜0.0001);a significant reduction in mortality in the hypothermia groups(RR=0.73,95%CI:0.58-0.91,P=0.005);a significant reduction in major neurodevelopmental disability in survivors in the hypothermia groups(RR=0.63, 95%CI:0.48-0.84,P=0.001);significantly increased sinus bradycardia in hypothermia groups(RR=6.35,95%CI:2.33-18.29,P=0.0004);failed to show a significant effect of therapeutic hypothermia on the incidence of cardiac arrhythmia requiring medical intervention,coagulopathy resulting in major thrombosis or haemorrhage,sepsis and seizures.It failed to show significant difference in mortality rates before 3 years old between anticonvulsants with standard therapy(RR=1.13,95%CI:0.59-2.17, P=0.72);also showed no significant difference in rates of severe neurodevelopmental disability(RR=0.61,95%CI:0.30-122,P=0.16).It failed to show significant difference in mortality rates during the neonatal period and during infancy between allopurinol with standard therapy(RR=0.92,95%CI:0.59-1.45,P=0.73);failed to show a significant effect in the rate of severe quadriplegia in surviving infants. Naloxone significantly increased the effectiveness rate in HIE(RR=0.28,95%CI: 0.22-0.37,P＜0.00001);significantly reduced mortality(RR=0.31,95%CI:0.13-0.75, P=0.009).Hyperbaric oxygen significantly reduced mortality(RR=0.34,95%CI: 0.18-0.64,P=0.0008);Neurological sequelae were significantly reduced in neonates treated with hyperbaric oxygen compared with controls(RR=0.43,95%CI:0.27-0.69, P=0.0003).[Conclusions](1)Therapeutic hypothermia is beneficial to term newborns with HIE. Cooling reduces mortality without increasing major disability in survivors without severe adverse effects.(2)The benefits of anticonvulsant therapy to term infants in the immediate period following perinatal asphyxia was not sure,can't be recommended for routine clinical practice.(3)The available data are not sufficient to determine whether allopurinol has clinically important benefits for newborn infants with HIE and larger trials are needed to evaluate the benefits and safety of allopurinol therapy. (4)The results suggest that treatment with naloxone may increase effectiveness rate and reduce mortality and neurological sequelae in term neonates with HIE.But trial reports were poor quality,only one trial shows naloxone can't reduce the mortality.The neglection of negative results indicates there maybe publication bias. An adequately powered,high quality randomised controlled trial is needed to develop in the future.(5)Most of the criteria used to diagnose HIE in the hyperbaric oxygen trials in China were established in Hangzhou,1997.It may included some asphyxiated infants without encephalopathy,which may exaggerate the effect.Trials used various doses of hyperbaric oxygen,which may lack of reliability.The low quality assessment and publication bias indicates that an adequately powered,high quality,randomised controlled trial is needed to investigate the effectiveness of hyperbaric oxygen in term neonates with hypoxic-ischaemic encephalopathy.