Traditional Chinese medicine for neonatal hypoxic-ischemic encephalopathy: A Bayesian network meta-analysis

Ethnopharmacological relevance: Although therapeutic hypothermia is currently considered an effective treatment for neonatal hypoxic-ischemic encephalopathy (HIE), neonatal HIE is a disease requiring multiple therapeutic measures. Related Chinese herbal injections (CHIs) have been carried out in Chinese local hospitals for several years, and the outcomes all seem to show positive results. At the same time, other Traditional Chinese medicine (TCM) methods have also shown vigorous vitality.Aim of the study: This study constructed a network meta-analysis (NMA) to investigate the efficacy of CHIs including Shenmai Injection (SMI), Compound musk injection (SXI), Ligustrazine injection (CXI), Compound danshen injection (DSI), Astragalus injection (HQI), Ginkgo biloba extract injection (YXI), and Puerarin injection (GGI) combined with traditional symptomatic treatment (TST) and TST alone in HIE.Methods: A literature review was conducted in several databases from inception to 9 February 2023. The quality of the included studies was assessed by the Cochrane risk of bias tool. Data were analyzed by STATA 17.0 and R 4.2.2 software. Surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments. Bayesian network meta-analysis was designed to access the effectiveness of different CHIs.Results: A total of 46 eligible randomized controlled trials involving 3,448 patients and 7 CHIs were included. The results of the NMA showed that SMI, SXI, CXI, DSI, HQI, YXI, and GGI combined with TST significantly improved treatment performance compared to TST alone. SMI + TST had obvious superiorities in the clinical effective rate and the original reflection recovery time. SXI + TST was the most advantageous in the Cure rate and the Neonatal Behavioral Neurological Assessment (NBNA). CXI + TST was shown to reduce the incidence of sequelae best. All articles reported that there were no obvious adverse drug reactions/adverse drug events (ADRs/ADEs).Conclusion: This NMA showed that using CHIs in combination with TST improved treatment performance and could be beneficial for patients with HIE compared to using TST alone. Thereinto, SXI + TST showed a preferable improvement in patients with HIE when unified considering the clinical effective rate and other outcomes. As for safety, more evidence is needed to support this hypothesis.

Automated summary

This study conducted a network meta-analysis to investigate the efficacy of Chinese herbal injections (CHIs) combined with traditional symptomatic treatment (TST) for neonatal hypoxic-ischemic encephalopathy (HIE). The results showed that CHIs combined with TST significantly improved treatment performance compared to TST alone, with SXI + TST showing the most preferable improvement.