Supplementary Material for: Post-asphyxial aftercare and management of neonates in low- and middle-income countries – A systematic evidence synthesis

Background: Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aims to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low-and middle-income countries (LMICs). Evidence was generated by performing de-novo reviews, updates to reviews via systematic searches and re-analysis of studies conducted in LMICs from existing reviews. Summary: 61 trials recruiting 5046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, anti-seizure medications, and early interventions to improve developmental outcomes. Our re-analysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities. Key Messages: The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift towards prevention, and strategies that emphasize improving antenatal and obstetric care.

背景：新生儿窒息复苏后有效护理对改善其预后至关重要。本综述旨在全面概述窒息后护理策略，同时作为补充内容的一部分，该补充内容针对中低收入国家（low-and middle-income countries, LMICs）的新生儿有效干预措施开展了系统性综合总结。本综述的证据来源于原创综述、通过系统检索完成的综述更新，以及对现有综述中纳入的中低收入国家相关研究的重新分析。
总结：本综述共纳入61项试验，涉及5046名窒息后足月儿，覆盖所有干预领域。针对中低收入国家的液体限制、抗癫痫药物治疗以及改善发育结局的早期干预相关研究较为匮乏。我们对中低收入国家全身亚低温试验的重新分析发现，其对新生儿死亡率、婴儿期死亡率或神经残疾的影响，因护理中心及所用亚低温设备类型的不同而存在显著差异。在中低收入国家开展的27项试验评估了神经保护药物治疗方案，此类疗法在脑病新生儿中的疗效存在差异。其中绝大多数试验（60%）聚焦于硫酸镁治疗，该疗法可显著改善新生儿短期死亡率及并发症发生情况。
关键信息：纳入试验的样本量普遍偏小，证据质量从极低至中等不等。关于长期生存与神经发育结局的相关证据较为有限。亟需针对具有应用前景的神经保护治疗方案，以及影响其在低资源环境中落地实施的相关因素开展进一步研究。为减轻中低收入国家新生儿窒息带来的沉重疾病负担，本综述强调亟需实现诊疗范式向预防方向的转变，并推广旨在优化产前与产科护理的相关策略。