Neuroprotective strategies of neonatal encephalopathy in low-resource settings

Abstract

Objective: Perinatal asphyxia followed by hypoxic ischemic encephalopathy is a major contributor to neonatal death. In high-income countries therapeutic hypothermia is the standard of care. However, safety and efficacy of cooling have not been proven in low- and middle income countries, who bear most of the burden of neonatal encephalopathy. This article reviews the entry criteria of cooling in developing countries and the feasibility, safety and efficacy of different low-cost cooling techniques. Furthermore, we discuss whether other neuroprotective therapies could be used.

Methods: We searched in PubMed and other databases for studies regarding entry criteria, low-cost cooling techniques and other neuroprotective therapies for neonatal encephalopathy in low- and middle income countries.

Results: A 5-minute Apgar score less than six and a Thompson score more than six are useful entry criteria for cooling in low-resource settings. Effective cooling was feasible with different low-cost cooling techniques, but a servo-controlled device maintained the most stable temperature profile and seems to be the most safe and easiest to use device. Only a few studies were powered to assess efficacy. None of the studies could show a significant decrease in mortality rate. When the rate of death and developmental delay were combined, they could notice a significant decrease in the hypothermia group. A promising drug to provide neuroprotection in low-resource settings is 2-iminobiotin.

Conclusions: To assess safety and efficacy of therapeutic hypothermia and other neuroprotective drugs in low-resource settings we need more adequately powered clinical trials.