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.