Neonatal Hypoxic-Ischemic Encephalopathy Diagnosis and Treatment: A National Survey in China

Abstract

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) affects as many as 100,000 infants each year in China. Therapeutic hypothermia reduces HIE related mortality and long-term neurodevelopmental disabilities. National guidelines for HIE management were published a decade ago. This study aimed to investigate the current status of HIE diagnosis and treatment in China. Method: This prospective cross-sectional national survey used a questionnaire evaluating practices related to HIE management. Descriptive statistics and Chi-square or Fisher's exact test were used, and a p-value of <0.05 was considered significant. Results: The 273 hospitals that completed the survey were located in 31 of the 34 provincial districts in China. Eighty-eight percent of the hospitals were Level III hospitals, and 74% treated ten or more HIE cases annually. Awareness rates of the national guidelines for HIE diagnosis, HIE treatment, and therapeutic hypothermia protocol were 85%, 63%, and 78%, respectively. Neurological manifestations and blood gas were used as HIE diagnostic criteria by 96% (263/273) and 68% (186/273) of the hospitals, respectively. Therapeutic hypothermia was used in 54% (147/273) of hospitals. The percentage of general hospitals that implemented therapeutic hypothermia (43%, 71/165) was significantly lower than that in maternity and infant hospitals (67%, 49/73) (χ2=11.752, p=0.001) and children’s hospitals (77%, 27/35) (χ2=13.446, p<0.001). Reasons for not providing therapeutic hypothermia included reduction of HIE cases in recent years (39%), high cost of cooling devices and treatment (31%), lack of training (26%), and safety concerns (4%). Among the hospitals that provided therapeutic hypothermia, 27% (39/147) were in full compliance with the recommended protocol. Eighty-one percent (222/273) of the hospitals treated HIE infants with putative neuroprotective agents alone or in combination with cooling. Ninety-one percent of the hospitals had long-term neurodevelopmental follow-up programs for infants with HIE. Conclusions: There is significant heterogeneity in HIE diagnosis and treatment in China. Therapeutic hypothermia has not become a standard of care for neonatal HIE nationwide. Unproven agents are widely used for HIE treatment. Nationwide standardization of HIE management and dissemination of therapeutic hypothermia represent the opportunities to reduce mortality and improve long-term neurodevelopmental outcomes of children affected by HIE.

Maternal and neonatal exposure to risk factors for neonates with moderate or severe hypoxic ischemic encephalopathy: a cross-sectional study

“…Neonatal HIE accounts for 15.2% of mortality under the age of five, in addition, the mortality rate of neonatal moderate or severe HIE is high, and the rate of severe neurological disability in survivors is up to 55%-73% [ 6 ]. Despite of significant improvements in neonatal care, HIE continues to exist in developed countries and a disproportionately high burden remains in low and middle income countries [ 7 – 11 ]. There are 15–18 million live births in China each year, and the incidence of neonatal HIE is estimated to be 3–6 per 1000 live births [ 12 ].…”

Maternal And Neonatal Exposure To Risk Factors For Neonates With Moderate Or Severe Hypoxic Ischemic Encephalopathy: A Cross-Sectional Study

“…Neonatal HIE accounts for 15.2% of mortality under the age of ve, in addition, the mortality rate of neonatal moderate or severe HIE is high, and the rate of severe neurological disability in survivors is up to 55%-73% [6] . Despite of signi cant improvements in neonatal care, HIE continues to exist in developed countries and a disproportionately high burden remains in low and middle income countries [7][8][9][10][11] . There are 15-18 million live births in China each year, and the incidence of neonatal HIE is estimated to be 3-6 per 1000 live births [12] .…”

“…7, intrauterine distress, amniotic uid contamination are risk factors for moderate or severe HIE. Notably, we found no biological interaction between risk factors based on the additive model.…”

Scutellarin protects cortical neurons against neonatal hypoxic‐ischemic encephalopathy injury via upregulation of vascular endothelial growth factor

“…To date, current strategies for clinical therapies involve anticonvulsants, hypothermia, electrolyte, and fluid management, as well as atropine and adrenaline applications. Nevertheless, there is still a lack of effective therapeutic approaches, primarily as a result of lacking mechanistic understanding of the pathophysiology of NHIE 7–9 . Therefore, the effective prevention and control measures in the study of the pathogenesis of NHIE should be urgently identified and developed 10–12 …”