A Randomized Clinical Trial of Therapeutic Hypothermia Mode during Transport for Neonatal Encephalopathy

Akula, Vishnu Priya; Joe, Priscilla; Thusu, Kajori; Davis, Alexis S.; Tamaresis, John; Kim, Sun-Hwa; Shimotake, Thomas K.; Butler, Stephen; Honold, Jose; Kuzniewicz, Michael W.; DeSandre, Glenn; Bennett, Mihoko V.; Gould, Jeffrey R.; Wallenstein, Matthew B.; Meurs, Krisa P. Van

doi:10.1016/j.jpeds.2014.12.061

Cited by 67 publications

(56 citation statements)

References 26 publications

(39 reference statements)

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“…21 A recent clinical trial in the transport setting demonstrated that active cooling using a servo controlled device resulted in a greater number of babies achieving the target temperature than with passive cooling. 22 The term HIE is used from this point as it is assumed other possible aetiologies of encephalopathy are excluded.…”

Section: Advances In the Management Of Hie Resuscitationmentioning

confidence: 99%

Management and investigation of neonatal encephalopathy: 2017 update

Martinello

Hart

Yap

et al. 2017

Arch Dis Child Fetal Neonatal Ed

145

122

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This review discusses an approach to determining the cause of neonatal encephalopathy, as well as current evidence on resuscitation and subsequent management of hypoxic-ischaemic encephalopathy (HIE). Encephalopathy in neonates can be due to varied aetiologies in addition to hypoxic-ischaemia. A combination of careful history, examination and the judicious use of investigations can help determine the cause. Over the last 7 years, infants with moderate to severe HIE have benefited from the introduction of routine therapeutic hypothermia; the number needed to treat for an additional beneficial outcome is 7 (95% CI 5 to 10). More recent research has focused on optimal resuscitation practices for babies with cardiorespiratory depression, such as delayed cord clamping after establishment of ventilation and resuscitation in air. Around a quarter of infants with asystole at 10 min after birth who are subsequently cooled have normal outcomes, suggesting that individualised decision making on stopping resuscitation is needed, based on access to intensive treatment unit and early cooling. The full benefit of cooling appears to have been exploited in our current treatment protocols of 72 hours at 33.5°C; deeper and longer cooling showed adverse outcome. The challenge over the next 5–10 years will be to assess which adjunct therapies are safe and optimise hypothermic brain protection in phase I and phase II trials. Optimal care may require tailoring treatments according to gender, genetic risk, injury severity and inflammatory status.

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Section: Advances In the Management Of Hie Resuscitationmentioning

confidence: 99%

Management and investigation of neonatal encephalopathy: 2017 update

Martinello

Hart

Yap

et al. 2017

Arch Dis Child Fetal Neonatal Ed

145

122

View full text Add to dashboard Cite

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“…In a retrospective, single-centre study, Goel et al [15] reported a median time to target temperature of 30 min using a servo-controlled cooling device compared with 130 min using manual cooling techniques during transport. In a multi-centre randomised trial, Akula et al [26] reported a significantly higher percentage of infants in the device group reaching the target temperature during transport compared with the control group (an odds ratio of 1.6). Additionally, Chaudhary et al [16] demonstrated a significant reduction in the median stabilisation time as well as the age of infants on arrival at NICU following the introduction of servo-controlled cooling during transport.…”

Section: Discussionmentioning

confidence: 99%

Impact of Education on Hypothermia Delivery during Neonatal Transport

et al. 2019

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Background: Moderate therapeutic hypothermia (TH) initiated within 6 h of life reduces adverse neurodevelopmental outcomes in infants after perinatal hypoxic ischaemic insult. For infants born in non-tertiary centres, TH may be initiated manually en route to a neonatal intensive care unit (NICU). However, both over- and undercooling is reported with this strategy, precluding some infants from the benefits of TH. Objectives: To evaluate the impact of a region-wide educational programme on the safety and efficacy of manual cooling administered by the Wellington Neonatal Transport Service (NeTS). Methods: Clinical records of infants with hypoxic ischaemic encephalopathy (HIE) retrieved by the Wellington NeTS for TH between January 2012 and June 2017 were reviewed retrospectively. Temperature outcomes of infants retrieved before and after the education programme were compared. Results: A total of 101 infants were cooled manually by Wellington NeTS for TH during the study period. Education and training significantly reduced the rate of overcooling to ≤32.0°C (4/43 [9%] vs. 0/58, p = 0.02). However, there was no difference in the proportion of infants who achieved target rectal temperature within 6 h of life (29/43 [65%] vs. 35/58 [60%], p = 0.57). Conclusions: Introduction of a region-wide educational programme may have improved the safety of manual cooling during neonatal transport but it had a negligible impact on its efficacy. The use of servo-controlled cooling during transport should therefore be considered to improve access to the optimal neuroprotective benefits of TH for outborn infants with HIE.

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“…Temperature variability is less and temperature control better with servo-controlled devices in both the NICU [22,23] and during transport [8,9,11]. A recent randomised controlled trial reported that the target temperature was achieved during retrieval by 80% of infants cooled by a servo-controlled device, and 49% of infants cooled manually [10]. …”

Section: Discussionmentioning

confidence: 99%

“…In outborn infants with moderate or severe HIE, controlled whole-body hypothermia treatment to a target core body temperature of 33-34°C has been initiated by the neonatal transport team by removing external heat sources [4,5] and application of simple devices such as refrigerated gel packs [3,6]. More recently, some retrieval services have developed the capacity to use servo-controlled devices [7,8,9,10,11] although the weight and size of these systems may be problematic, particularly during air transport. Importantly, assessment of outborn infants with HIE by the transport team and initiation of hypothermia may be delayed, particularly in remote locations.…”

Section: Introductionmentioning

confidence: 99%

Earlier Initiation of Therapeutic Hypothermia by Non-Tertiary Neonatal Units in Victoria, Australia

2016

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Background: Therapeutic hypothermia is an effective treatment for moderate or severe hypoxic-ischaemic encephalopathy (HIE), with maximal neuroprotective benefit when initiated soon after birth.Early initiation of therapeutic hypothermia in infants with HIE born in geographically distant settings is challenging. Objective: To audit temperature control in infants with HIE treated with hypothermia during neonatal transport in Victoria, Australia. Methods: A retrospective database review from September 1, 2008 to August 31, 2012 compared temperatures of transported outborn infants with HIE treated with hypothermia initiated by the referring non-tertiary neonatal unit, with hypothermia initiated by the transport team. Results: 123 infants received therapeutic hypothermia during the study period. Hypothermia treatment commenced significantly earlier [median (interquartile range [IQR]) 1.1 h (0.6-1.7) vs. 3.3 h (2.1-4.5); p < 0.01] with the target temperature (33-34°C) achieved sooner [median (IQR) 3.4 h (2.4-4.6) vs. 4.5 h (3.6-5.5)] when initiated by the referring hospital (n = 71) than by the transport team (n = 52). There was no statistically significant difference in achieving the target temperature before admission to the tertiary neonatal intensive care unit when hypothermia was initiated by the referring unit, compared with by the transport team [51/71 (71.8%) vs. 28/52 (53.9%), odds ratio (95% CI) 2.19 (0.96, 4.96)]. Infants in whom hypothermia was initiated by the referring hospital were more likely to have a recorded temperature below 33°C [22/71 (31.0%) vs. 4/52 (7.7%), odds ratio (95% CI) 5.39 (1.64, 22.83)]. Conclusions: The target temperature is achieved sooner in infants with moderate or severe HIE when therapeutic hypothermia is initiated by referring non-tertiary neonatal units under guidance from the regional transport service. This practice may enhance neuroprotection for infants with HIE born in non-tertiary units, particularly in remote locations.

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A Randomized Clinical Trial of Therapeutic Hypothermia Mode during Transport for Neonatal Encephalopathy

Cited by 67 publications

References 26 publications

Management and investigation of neonatal encephalopathy: 2017 update

Management and investigation of neonatal encephalopathy: 2017 update

Impact of Education on Hypothermia Delivery during Neonatal Transport

Earlier Initiation of Therapeutic Hypothermia by Non-Tertiary Neonatal Units in Victoria, Australia

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