Abstract
BackgroundGanglioside has a neuroprotective role in neonatal hypoxic–ischemic encephalopathy (HIE). This study aimed to evaluate the neurological outcomes of monosialoganglioside as adjuvant treatment for neonatal HIE by conducting a meta-analysis.MethodsA comprehensive literature search was made in the Pubmed, EMBASE, Cochrane Library, Wanfang, CNKI, VIP databases through October 2016. Randomized controlled trials comparing monosialoganglioside with the usual treatment for newborns having HIE deemed eligible. Weighted mean difference (WMD) and risk ratio (RR) with 95% confidence interval (CI) were calculated for continuous and dichotomous data, respectively.ResultsTen trials consisting of 787 neonates were included. Adjuvant treatment with monosialoganglioside significantly reduced major neurodevelopmental disabilities (RR = 0.35; 95% CI = 0.21–0.57), cerebral palsy (RR = 0.32; 95% CI = 0.12–0.87), mental retardation (RR = 0.31; 95% CI = 0.11–0.88) as well as improved the mental (WMD = 14.95; 95% CI = 7.44–22.46) and psychomotive (WMD = 13.40; 95% CI = 6.69–20.11) development index during the follow-up. Also, monosialoganglioside significantly improved Neonatal Behavioral Neurological Assessment scores (WMD = 2.91; 95% CI = 2.05–3.78) compared with the usual treatment. However, adverse effects associated with monosialoganglioside were poorly reported in the included trials.ConclusionAdjuvant treatment with monosialoganglioside had beneficial effects in improving neurological outcomes in neonatal HIE. However, these findings should be interpreted with caution because of methodological flaws in the included trials. Furthermore, safety of monosialoganglioside use should also be further evaluated.
Highlights
Neonatal hypoxic ischemic encephalopathy (HIE) is a common cause of brain damage secondary to perinatal asphyxia, affecting 1 to 8 per 1000 live full-term births [1]
Adjuvant treatment with monosialoganglioside significantly reduced major neurodevelopmental disabilities (RR = 0.35; 95% confidence interval (CI) = 0.21–0.57), cerebral palsy (RR = 0.32; 95% CI = 0.12–0.87), mental retardation (RR = 0.31; 95% CI = 0.11–0.88) as well as improved the mental (WMD = 14.95; 95% CI = 7.44–22.46) and psychomotive (WMD = 13.40; 95% CI = 6.69–20.11) development index during the follow-up
Monosialoganglioside significantly improved Neonatal Behavioral Neurological Assessment scores (WMD = 2.91; 95% CI = 2.05–3.78) compared with the usual treatment
Summary
Neonatal hypoxic ischemic encephalopathy (HIE) is a common cause of brain damage secondary to perinatal asphyxia, affecting 1 to 8 per 1000 live full-term births [1]. The majority of neonates with mild HIE are usually associated with normal outcomes [4]. Severe HIE contributes to a higher risk of neonatal death as well as long-term neurologic disabilities, including cerebral palsy, mental retardation, learning disability, and epilepsy [5]. Therapeutic hypothermia has been considered as standard treatment for neonates with moderate to severe HIE but is only partially effective [6]. For high rates of neurologic morbidities caused by HIE, development of new therapeutic agents is needed for the management of neonatal HIE. This study aimed to evaluate the neurological outcomes of monosialoganglioside as adjuvant treatment for neonatal HIE by conducting a meta-analysis
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