title: Hypothermia for perinatal brain hypoxia-ischemia in different resource settings: a systematic review.
abstract: OBJECTIVE
  To assess the effect of hypothermia on mortality of neonates with hypoxic-ischemic encephalopathy in different economic resources settings.
  
  
  METHODS
  We searched for randomized controlled trials on MEDLINE, Embase and other databases. Duplicate reviewers selected the studies and extracted data. We calculated meta-analyses of the relative risks (RR) and 95% confidence intervals (95% CI), and used meta-regression to evaluate the gross domestic product per capita influence on hypothermia efficacy.
  
  
  RESULTS
  Sixteen studies were included (n = 1889); eight were conducted in lower income countries (n = 662). Hypothermia significantly reduced mortality (RR = 0.77; 95% CI: 0.65-0.92). Meta-regression revealed that hypothermia efficacy does not increase as the gross domestic product per capita rises.
  
  
  CONCLUSIONS
  There is enough evidence to support hypothermia as the standard care for hypoxic-ischemic encephalopathy. Evidence from low-resource settings is limited, but hypothermia efficacy was not shown to be associated with better resources countries.
authors.affiliation: University of Brasilia, Faculty of Medicine, Brasilia, Distrito Federal, 70910-900, Brazil.
authors.forename: Tais F
authors.initials: TF
authors.lastname: Galvao
authors.forename: Marcus T
authors.initials: MT
authors.lastname: Silva
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Marques
authors.forename: Nelson D
authors.initials: ND
authors.lastname: de Oliveira
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Pereira
mesh_terms: D005260:Female; D006295:Health Resources; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000401:mortality / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: brain hypoxia-ischemia; developing countries; induced hypothermia; newborn infant