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Investigating the Safety and Efficacy of Therapeutic Hypothermia in Pediatric Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis Publisher



Naseri Alavi SA1 ; Habibi MA2 ; Majdi A3 ; Hajikarimloo B4 ; Rashidi F5 ; Fathi Tavani S5 ; Minaee P6 ; Eazi SM6 ; Kobets AJ7
Authors
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Authors Affiliations
  1. 1. Department of Neurosurgery, School of Medicine, Emory University, Atlanta, 30033, GA, United States
  2. 2. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, 14399, Iran
  3. 3. Research Group Experimental Oto-Rhino-Laryngology, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, 3000, Belgium
  4. 4. Department of Neurosurgery, Shohada Tajjrish Hospital, Shahid Beheshti University of Medical Science, Tehran, 14399, Iran
  5. 5. School of Medicine, Tehran University of Medical Sciences, Tehran, 14399, Iran
  6. 6. Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom, 999067, Iran
  7. 7. Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, 10467, NY, United States

Source: Children Published:2024


Abstract

Background: Prior guidelines recommended maintaining normothermia following traumatic brain injury (TBI), but recent studies suggest therapeutic hypothermia as a viable option in pediatric cases. However, some others demonstrated a higher mortality rate. Hence, the impact of hypothermia on neurological symptoms and overall survival remains contentious. Methods: We conducted a systematic review and meta-analysis to evaluate the effects of hypothermia on neurological outcomes in pediatric TBI patients. The PubMed/Medline, Scopus, and Web of Science databases were searched until 1 January 2024 and data were analyzed using appropriate statistical methods. Results: A total of eight studies, comprising nine reports, were included in this analysis. Our meta-analysis did not reveal significant differences in mortality (RR = 1.58; 95% CI = 0.89–2.82, p = 0.055), infection (RR = 0.95: 95% CI = 0.79–1.1, p = 0.6), arrhythmia (RR = 2.85: 95% CI = 0.88–9.2, p = 0.08), hypotension (RR = 1.54: 95% CI = 0.91–2.6, p = 0.10), intracranial pressure (SMD = 5.07: 95% CI = −4.6–14.8, p = 0.30), hospital length of stay (SMD = 0.10; 95% CI = −0.13–0.3, p = 0.39), pediatric intensive care unit length of stay (SMD = 0.04; 95% CI = −0.19–0.28, p = 0.71), hemorrhage (RR = 0.86; 95% CI = 0.34–2.13, p = 0.75), cerebral perfusion pressure (SMD = 0.158: 95% CI = 0.11–0.13, p = 0.172), prothrombin time (SMD = 0.425; 95% CI = −0.037–0.886, p = 0.07), and partial thromboplastin time (SMD = 0.386; 95% CI = −0.074–0.847, p = 0.10) between the hypothermic and non-hypothermic groups. However, the heart rate was significantly lower in the hypothermic group (−1.523 SMD = −1.523: 95% CI = −1.81–−1.22 p < 0.001). Conclusions: Our findings challenge the effectiveness of therapeutic hypothermia in pediatric TBI cases. Despite expectations, it did not significantly improve key clinical outcomes. This prompts a critical re-evaluation of hypothermia’s role as a standard intervention in pediatric TBI treatment. © 2024 by the authors.
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