Acupuncture for hypoxic ischemic encephalopathy in neonates

Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. .
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2013; 1(1):CD007968. DOI: 10.1002/14651858.CD007968.pub2
Source: PubMed

ABSTRACT Hypoxic ischemic encephalopathy (HIE) in the neonate is associated with high mortality and morbidity. Effective treatment options are limited and therefore alternative therapies such as acupuncture are increasingly used.
We sought to determine the efficacy and safety of acupuncture on mortality and morbidity in neonates with HIE.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Cochrane Neonatal Specialized Register, MEDLINE, AMED, EMBASE, PubMed, CINAHL, PsycINFO, WHO International Clinical Trials Registry Platform, and various Chinese medical databases in November 2012.
We planned to include randomized or quasi-randomized controlled trials comparing needle acupuncture to a control group that used no treatment, placebo or sham treatment in neonates (less than 28 days old) with HIE. Co-interventions were allowed as long as both the intervention and the control group received the same co-interventions. We excluded trials that evaluated therapy that did not involve penetration of the skin with a needle or trials that compared different forms of acupuncture only.
Two review authors independently reviewed trials for inclusion. If trials were identified, the review authors planned to assess trial quality and extract data independently. We planned to use the risk ratio (RR), risk difference (RD), and number needed to benefit (NNTB) or harm (NNTH) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CI for continuous outcomes.
No trial satisfied our predefined inclusion criteria. Existing trials only evaluated acupuncture in older infants who survived HIE. There are currently no randomized controlled trials evaluating the efficacy of acupuncture for treatment of HIE in neonates. The safety of acupuncture for HIE in neonates is unknown.
The rationale for acupuncture in neonates with HIE is unclear and the evidence from randomized controlled trial is lacking. Therefore, we do not recommend acupuncture for the treatment of HIE in neonates. High quality randomized controlled trials on acupuncture for HIE in neonates are needed.

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    • "The results are eagerly awaited. Also a study protocol for a Cochrane Review proposes to evaluate the effect of acupuncture in neonates with hypoxic ischemic encephalopathy compared with standard care but the details have never been published [30]. "
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    ABSTRACT: The aim of the paper was to review the literature about safety and efficiency of acupuncture therapy in term and preterm infants. We searched Medline, EMBASE, and Cochrane Central Register of Controlled Trials using a predefined algorithm, reviewed abstracts from the Pediatric Academic Society annual meetings (2000-2012), and performed a manual search of references in narrative and systematic reviews. A total of 26 studies identified met our search criteria. Only 6 of these studies met our inclusion criteria; however, two studies had to be excluded because the manuscripts were published in Chinese. Hence, only four studies were included in our analysis. Three of the four studies evaluated the effects of acupuncture on infantile colic, and one assessed pain reduction during minor painful procedures in preterm babies. The limited data available suggests that acupuncture could be a safe nonpharmacologic treatment option for pain reduction in term and preterm infants and could also be a non-pharmacologic treatment option to treat infantile colic. Currently acupuncture in infants should be limited to clinical trials and studies evaluating short- and long-term effects and should be performed only by practitioners with adequate training and experience in neonatal/pediatric acupuncture.
    Evidence-based Complementary and Alternative Medicine 06/2013; 2013:739414. DOI:10.1155/2013/739414 · 1.88 Impact Factor
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    ABSTRACT: Abstract Background: Cochrane Systematic Reviews (CSRs) are frequently referenced by acupuncture efficacy studies currently. In this study, the CSRs on acupuncture are reviewed, and the disease fields they covered and the conclusions they reached are analyzed. In order to explore the potential contribution to CSRs by Chinese resources, the authors analyzed whether the participation of Chinese reviewers, the utilization of Chinese databases, and the inclusion of Chinese clinical trials would affect the positive conclusion ratios of the CSRs. Methods: Acupuncture-related CSRs in the Cochrane Library were searched and classified based on the International Classification of Diseases-10 (ICD-10). The CSRs were further designated as positive or negative according to the conclusion statements. CSRs with the participation of Chinese reviewers, the utilization of Chinese databases, or the inclusion of Chinese clinical trials were extracted, and the positive ratios of conclusions were compared separately with corresponding CSRs without those three Chinese resources. Results: Thirty-two (32) CSRs were identified, 9 (28.1%) of which reached positive conclusions. The CSRs with positive conclusions were mainly about multifarious pains, nausea and vomiting, and functional disorders. Seventeen (17; 53.1%) included the participation of Chinese reviewers, 18 (56.3%) involved the utilization of Chinese databases, and 20 (62.5%) included Chinese clinical trials. No differences on the positive conclusion ratios were observed between CSRs with reviewers from Chinese institutions and those that did not (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.06, 1.62), the utilization of Chinese databases and those that did not (OR: 0.51, 95% CI: 0.11, 2.44), or the inclusion of Chinese clinical trials and those that did not (OR: 1.29, 95% CI: 0.26, 6.49). Conclusions: Most CSRs on acupuncture are inconclusive. No significant differences regarding the positive conclusion ratios were found between the CSRs with or without the utilization of Chinese resources.
    Journal of alternative and complementary medicine (New York, N.Y.) 02/2013; 19(7). DOI:10.1089/acm.2012.0113 · 1.52 Impact Factor
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    ABSTRACT: Abstract Background: Despite great efforts in the past 20 years, there is still a need for more suitable therapeutic options in neonatology. Complementary and alternative medicine could offer such opportunities. Objective: To determine the present state of knowledge on the use of acupuncture in neonates, this is an update of a formerly published study. Design: Performing a systematic literature review in Medline, BIOSYS Previews, DAHTA, Deutsches Ärzteblatt, EMBASE, EMBASE alert, gms, gms-Meetings, Karger-Verlagsdatenbank, Krause & Pachernegg Verlagsdatenbank, SciSearch, Thieme-Verlagsdatenbank PrePrint, Thieme-Verlagsdatenbank. Keywords were: neonatology, newborn, preterm, acupuncture, laser acupuncture; furthermore considerations from theoretical and practical points of view. Results: We have found one randomized controlled study, one study with a crossover design, one observational study, one study concerning methodology, 3 case reports, 2 reviews and one protocol for a Cochrane Review. Discussion: This topic has not yet really been evaluated scientifically, the literature is very scarce. According to international literature, acupuncture does not play a significant role in the treatment of children so far, not only in neonatology. The results of the Cochrane protocol could provide an assessment and may contribute to a better understanding. The other papers represent some interesting ideas that need further research. There is some practical limitation for acupuncture especially for very young infants. Conclusion: If acupuncture is practiced in neonates it needs further evaluation.
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