Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists

Burnsed, Jennifer; Zanelli, Santina

doi:10.1111/apa.13983

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…In 2013, a paper on the implementation of TH in the Netherlands and Flanders reported a successful introduction of this intervention with results similar to the major trials [5]. Currently, TH is the only clinically available therapy proven to be effective in infants with moderate to severe NE [6].…”

Section: Introductionmentioning

confidence: 99%

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

et al. 2020

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Introduction: Adverse outcomes have been reported in infants with mild neonatal encephalopathy (NE). Increasing clinical experience with the application of therapeutic hypothermia (TH) may have resulted in the treatment of newborns with milder NE during recent years. Objective: To determine whether infants treated with TH in the initial years following implementation had a higher degree of NE than infants treated during subsequent years. Methods: Infants with NE treated with TH from February 2008 until July 2017 were included. Thompson and Sarnat scores, amplitude-integrated electroencephalography (aEEG) background patterns before the start of TH, and neurodevelopmental outcome at 2 years were compared between infants treated from February 2008 until October 2012 (period 1) and infants treated from November 2012 until July 2017 (period 2). Results: 211 newborns with NE were treated with TH (period 1: n = 109, period 2: n = 102). Sarnat scores in period 1 and 2 were mild in 7.3 vs. 28.4%, moderate in 66.1 vs. 44.1%, and severe in 26.6 vs. 22.5%, respectively (p = 0.008). Thompson scores were lower in period 2 (median = 9, IQR 7–12) than in period 1 (median = 10, IQR 8.5–13.5, p = 0.018). The aEEGs and neurodevelopmental outcomes were comparable between the periods. Conclusions: Based on Thompson and Sarnat scores, but not aEEG background patterns, infants treated during the second period had milder NE than infants treated during the first years following implementation of TH. There was no difference in 2 years neurodevelopmental outcome. Further research is necessary to evaluate the value of TH for infants with clinically mild NE.

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Section: Introductionmentioning

confidence: 99%

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

et al. 2020

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“…First, there are already systematic reviews that have consolidated the evidence in the preterm populations for the use of the GMA in the prediction of neurodevelopmental outcomes, but this does not exist for the older gestational age groups [ 15 , 16 ]. Secondly, the benefit of therapeutic hypothermia for NE caused by HIE is established in infants ≥ 35 weeks GA, and ongoing research considers the extension of therapeutic hypothermia treatment to a GA younger than 35 weeks [ 4 , 5 , 30 ].…”

Section: Methodsmentioning

confidence: 99%

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age—a scoping review

et al. 2021

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Background The General Movements Assessment is a non-invasive and cost-effective tool with demonstrated reliability for identifying infants at risk for cerebral palsy. Early detection of cerebral palsy allows for the implementation of early intervention and is associated with better functional outcomes. No review to date has summarized the utility of the General Movements Assessment to predict cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy. Methods We conducted a scoping review involving infants born greater than or equal to 34 weeks gestational age to identify all available evidence and delineate research gaps. We extracted data on sensitivity, specificity, and positive and negative predictive values and described the strengths and limitations of the results. We searched five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL) and the General Movements Trust website. Two reviewers conducted all screening and data extraction independently. The articles were categorized according to key findings, and a critical appraisal was performed. Results Only three studies, a cohort and two case series, met all of the inclusion criteria. The total number of participants was 118. None of the final eligible studies included late-preterm neonates. All three studies reported on sensitivity, specificity, and positive predictive and negative predictive values. An abnormal General Movement Assessment at 3–5 months has a high specificity (84.6–98%) for cerebral palsy with a similarly high negative predictive value (84.6–98%) when it was normal. Absent fidgety movements, in particular, are highly specific (96%) for moderate to severe cerebral palsy and carry a high negative predictive value (98%) when normal. In the time period between term and 4–5 months post-term, any cramped synchronized movements had results of 100% sensitivity and variable results for specificity, positive predictive value, and negative predictive value. Conclusions A normal General Movements Assessment at 3 months in a term high-risk infant is likely associated with a low risk for moderate/severe cerebral palsy. The finding of cramped synchronized General Movements is a strong predictor for the diagnosis of cerebral palsy by 2 years of age in the term population with neonatal encephalopathy. The deficit of high-quality research limits the applicability, and so the General Movements Assessment should not be used in isolation when assessing this population. Systematic review registration Title registration with Joanna Briggs Institute. URL: http://joannabriggswebdev.org/research/registered_titles.aspx.

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“…Current eligibility criteria for therapeutic hypothermia has been determined by randomized controlled trials, supporting intervention in infants ≥ 35 weeks GA 41 . There are variations in practice with consideration for extension of treatment to younger gestational ages 42 . We therefore chose this GA to ensure we captured all the relevant literature.…”

Section: Participantsmentioning

confidence: 99%

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by two years of age - A scoping review.

Seesahai

Rotter

Luther

et al. 2021

Preprint

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BACKGROUND The General Movements Assessment is a non-invasive and cost-effective tool with demonstrated reliability for identifying infants at risk for cerebral palsy. Early detection of cerebral palsy allows for implementation of early intervention, and is associated with better functional outcomes. No review to date has summarized the utility of the General Movements Assessment to predict cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy.METHODS We conducted a scoping review involving infants born greater than or equal to 34 weeks gestational age to identify all available evidence and delineate research gaps. We extracted data on sensitivity, specificity, positive and negative predictive value and described the strengths and limitations of the results. We searched five databases (MEDLINE, Embase, PsychINFO, Scopus and CINAHL). Two reviewers conducted all screening and data extraction independently. The articles were categorized according to key findings and a critical appraisal performed.RESULTS From the electronic database search, only two studies, case series, met all of the inclusion criteria. The total number of participants were 60. Neither of the final eligible studies included late-preterm neonates. Both studies reported on sensitivity, specificity, positive predictive and negative predictive value. The newer study reported that in the time period between term and 4-5 months post-term, that any cramped synchronized movements in this time period had results of 100% sensitivity and variable results for specificity, positive predictive value and negative predictive value. Neither of the studies had infants that received therapeutic hypothermia for Neonatal Encephalopathy.CONCLUSIONS The finding of cramped synchronized General Movements is a strong predictor for the diagnosis of cerebral palsy by two years of age in the term population with neonatal encephalopathy. The deficit of high quality research limits the applicability and so the general movements assessment should not be used in isolation when assessing this population.Systematic review registrationTitle registration with Joanna Briggs Institute. URL: http://joannabriggswebdev.org/research/registered_titles.aspx

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Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists

Abstract: Significant variability in practice exists when caring for infants with HIE who do not meet standard inclusion criteria, emphasizing the need for continued and rigorous research in this area.

Cited by 13 publications

References 20 publications

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age—a scoping review

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by two years of age - A scoping review.

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