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Is therapeutic hypothermia beneficial for pediatric patients with traumatic brain injury? A meta-analysis

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Abstract

Purpose

Hypothermia therapy shows its unique potential for reducing mortality in animal study and improving neurologic outcome in patients with traumatic brain injury. However, therapeutic hypothermia for pediatric traumatic brain injury remains a controversial issue. To determine the effectiveness and safety of hypothermia treatment for pediatric traumatic brain injury patients, we conducted this meta-analysis.

Patients and methods

We analyzed the data from MEDLINE, Pubmed, EMBASE, and Cochrane Library by electronic searching. No limitation of language was selected for analysis. We extracted the mortality and adverse events from the published trials.

Results

Six clinical trials and 366 pediatric patients met our inclusion criteria. Pediatric patients with traumatic brain injury treated with hypothermia had more unfavorable outcome than those in the normothermia group (RR 1.73, 95 % CI 1.06 to 2.84), and this increased risk is statistically significant. Patients with therapeutic hypothermia are slightly likely to be induced by cardiac arrhythmia, and the likelihood is also significant (RR 2.57, 95 % CI 1.01 to 6.54). Risk of pneumonia has no statistical difference between normothermia and hypothermia arms (RR 0.90, 95 % CI 0.73 to 1.12). Two of the included trials have reported their detail randomization assignment.

Conclusions

Hypothermia may slightly increase the risk of mortality in children with traumatic brain injury and the ratio of cardiac arrhythmia after this hypothermia therapy is slightly higher than that in normothermia groups. In the future, more randomized controlled trials and multicenter studies on the mechanism of therapeutic hypothermia are required.

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Acknowledgments

This study was supported by the National Key Basic Research Program (NKBRP) (2010CB945203), The National Natural Science Foundation of China (81271382), and the Program of Shanghai Subject Chief Scientist (09XD1403300). The authors also acknowledge Dr. Lianming Wu and Prof. Xucheng Jiang for their critical suggestion.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Shanghai Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China

    Chenkai Ma, Xiaoguang He, Lin Wang, Baocheng Wang, Qifeng Li, Feng Jiang & Jie Ma

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  1. Chenkai Ma
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  2. Xiaoguang He
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  4. Baocheng Wang
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Correspondence to Jie Ma.

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Ma, C., He, X., Wang, L. et al. Is therapeutic hypothermia beneficial for pediatric patients with traumatic brain injury? A meta-analysis. Childs Nerv Syst 29, 979–984 (2013). https://doi.org/10.1007/s00381-013-2076-x

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  • DOI: https://doi.org/10.1007/s00381-013-2076-x

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