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 10 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.

Application Effect Analysis of Clinical Nursing Pathway in the Care of Neonatal Hypoxic-Ischemic Encephalopathy

“…As far as the healthy development of families and even the country is concerned, improving the survival rate and long-term neurodevelopmental outcome of children with HIE has huge implications [ 7 ]. At present, routine nursing mainly focuses on targeted treatment or nutritional support, which has no significant effect on improving neither the ND nor the long-term ND outcome of HIE children [ 8 ].…”

Neural Function Recovery and Safety of Mild Hypothermia Therapy Combined with Monosialotetrahexosylganglioside on Neonatal Asphyxia Complicated by Hypoxic Ischemic Encephalopathy

“…Neonatal hypoxic ischemic encephalopathy (HIE) is a common perinatal disease in clinic, which is mainly caused by perinatal asphyxia. In China, the incidence of HIE is increasing annually, which poses a serious threat to the life safety of neonates [ 1 ]. Even if the neonates survive, they may still suffer from severe neural dysfunction, which not only affects the development of intelligence but undoubtedly increases the socioeconomic and medical burden [ 2 ].…”

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

“…The preponderance of intervention studies from tertiary level referral hospitals from middle-income countries is likely to have further limited generalisability, but on the other hand use of therapeutic hypothermia is already widespread in such settings. [67][68][69][70] Further limitation on interpretation of the forest plots is that the Freeman Tukey back-transformation is prone to producing misleading results when sample sizes vary greatly, but we did not observe such issue in our data. 71 Lastly, although we conducted a systemic search of databases, 12 of the 53 included articles were identified from other sources indicating that the search terms used were not optimal and potential articles might have been missed.…”