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You work in a resource-poor country and cooling of infants with hypoxic ischaemic encephalopathy (HIE) is not available. A term baby is born with low Apgar scores and admitted to the neonatal unit, where you confirm moderate to severe HIE. As cooling is not available you wonder if starting phenobarbital (PB) would reduce mortality or disability.
Population Intervention Outcome (PICO)
In term babies with HIE in a low resource setting (patient) does prophylactic PB (intervention) compared with standard treatment alone (control) reduce mortality or disability (primary outcomes) or reduction in the occurrence of seizures (secondary outcome).
Cochrane, Pubmed and Embase were searched independently (February 2015) using the search strings (MeSH terms in italics): (Hypoxia-Ischemia, Brain OR Hypoxia, Brain OR hypoxic ischaemic encephalopathy OR hypoxic ischemic encephalopathy OR Encephalopathies, Hypoxic-Ischemic OR HIE OR Asphyxia OR Anoxia OR hypoxia) AND (infant, newborn OR newborn OR Neonatal OR Neonate OR neonates OR newborns) AND (phenobarbital OR phenobarbitone) AND (Developing Countries OR Poverty OR developing country OR resource-poor country OR low income country OR low-income country OR resource-poor country OR Global Health OR Third word). We included human studies which were experimental in nature and written in English. We excluded articles which only analysed surrogate markers.
These revealed nine, three and eight results for Cochrane, Pubmed and Embase, respectively, of which only one was relevant.1 The final search string (related to low-income countries) was therefore removed and the searches repeated to include studies from all resource levels. These revealed 35, 107 and 377 articles, respectively, of which ten,1–10 six,4 ,6–8 ,10 ,11 and eight1 ,2 ,4 ,6–10 were relevant. Two systematic reviews …
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