The impact of therapeutic hypothermia on developmental outcomes in lower-middle income countries: A systematic review and meta-analysis with a health equity lens.

Hypoxic-ischemic encephalopathy (HIE) from birth asphyxia is particularly burdensome on lower-middle income countries (LMICs). Our systematic review examined early and late developmental outcomes related to neonatal therapeutic hypothermia (TH) without disability thresholds or cut-offs pre-determined by high-income countries. A search of PubMed, Web of Science, and Embase databases yielded 364 articles; 11 studies met eligibility criteria. According to published standards for reporting of studies, 3 of the 11 studies were good quality and 8 studies were excellent. Within-group changes in early and late developmental outcomes showed large, significant effect sizes (d = -2.07; CI = -0.77, -3.36; d = 3.17; CI = 2.14, 4.21). Between-group differences showed significant effect sizes in late but not early developmental outcomes (d = 0.85; CI = 0.62, 1.07; d = -0.16; CI = -0.58, 0.25). The evidence indicates that TH improves developmental outcomes prior to hospital discharge and after 6 months, and surpasses standard of care for 6-month and later developmental outcomes.