Hypoxic-ischaemic encephalopathy code: A systematic review for resource-limited settings

Abstract

It is estimated that 96% of infants with hypoxic-ischaemic encephalopathy (HIE) are born in resource-limited settings with no capacity to provide the standard of care that has been established for nearly 15 years in high-resource countries, which includes therapeutic hypothermia (TH), continuous electroencephalographic monitoring and magnetic resonance imaging (MRI) in addition to close vital signs and haemodynamic monitoring. This situation does not seem to be changing; however, even with these limitations, currently available knowledge can help improve the care of HIE patients in resource-limited settings. The purpose of this systematic review was to provide, under the term "HIE Code", evidence-based recommendations for feasible care practices to optimise the care of infants with HIE and potentially help reduce the risks associated with comorbidity and improve neurodevelopmental outcomes. The content of the HIE code was grouped under 9 headings: (1) prevention of HIE, (2) resuscitation, (3) first 6h post birth, (4) identification and grading of encephalopathy, (5) seizure management, (6) other therapeutic interventions, (7) multiple organ dysfunction, (8) diagnostic tests and (9) family care.

Keywords: Convulsiones neonatales; Electroencephalographic monitoring; Encefalopatía hipóxico-isquémica; Encefalopatía neonatal; Entornos con recursos limitados; Hipotermia terapéutica; Hypoxic-ischaemic encephalopathy; Low-middle-income countries; Monitorización electroencefalográfica; Neonatal encephalopathy; Neonatal seizures; Neonate; Neonato; Países con bajos-medios recursos; Resource-limited settings; Therapeutic hypothermia.