Proposing a care practice bundle for neonatal encephalopathy during therapeutic hypothermia

Wintermark, Pia; Mohammad, Khorshid; Bonifacio, Sonia L.

doi:10.1016/j.siny.2021.101303

Cited by 14 publications

(5 citation statements)

References 163 publications

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“… 34 , 35 Our study findings suggest that center-driven practices such as increased EEG monitoring may play a role in improving neurodevelopmental outcomes in neonates with HIE, and are consistent with neuromonitoring guidelines proposed by the American Clinical Neurophysiology Society 36 and Newborn Brain Society. 37 …”

Section: Discussionmentioning

confidence: 99%

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

et al. 2023

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ImportanceIntercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.ObjectiveTo determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE.Design, Setting, and ParticipantsRetrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children’s hospitals participating in the Children’s Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022.ExposuresInfants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles.Main Outcomes and MeasuresThe main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared.ResultsAmong the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P &lt; .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P &lt; .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high– or medium–hospitalization cost centers and death or NDI. High– and medium–EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]). High– and medium–laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95% CI, 1.19-4.66]; medium vs low: OR, 1.93 [95% CI, 1.07-3.47]). High–antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95% CI, 1.51-9.18]; medium vs low: OR, 1.56 [95% CI, 0.71-3.42]).Conclusions and RelevanceHospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

et al. 2023

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“…The inverse correlation between admission temperature and rewarming rate suggests that the severity of the hypothermia might have influenced the health care providers, who decided about the speed of the rewarming in absence of a standardized protocol. In our series, most hypothermic neonates were rewarmed at <0.5°C/h, which was the threshold considered in previous studies ( 12 , 13 ) as it is the rewarming rate used in asphyxiated infants treated with therapeutic hypothermia ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Rewarming rate of hypothermic neonates in a low-resource setting: a retrospective single-center study

Rossi¹,

Maziku

Leluko

et al. 2023

Front. Pediatr.

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BackgroundHypothermic neonates need to be promptly rewarmed but there is no strong evidence to support a rapid or a slow pace of rewarming. This study aimed to investigate the rewarming rate and its associations with clinical outcomes in hypothermic neonates born in a low-resource setting.MethodsThis retrospective study evaluated the rewarming rate of hypothermic inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) in 2019–2020. The rewarming rate was calculated as the difference between the first normothermic value (36.5–37.5°C) and the admission temperature, divided by the time elapsed. Neurodevelopmental status at 1 month of age was assessed using the Hammersmith Neonatal Neurological Examination.ResultsMedian rewarming rate was 0.22°C/h (IQR: 0.11–0.41) in 344/382 (90%) hypothermic inborn infants, and was inversely correlated to admission temperature (correlation coefficient −0.36, p < 0.001). Rewarming rate was not associated with hypoglycemia (p = 0.16), late onset sepsis (p = 0.10), jaundice (p = 0.85), respiratory distress (p = 0.83), seizures (p = 0.34), length of hospital stay (p = 0.22) or mortality (p = 0.17). In 102/307 survivors who returned at follow-up visit at 1 month of age, rewarming rate was not associated with a potential correlate of cerebral palsy risk.ConclusionsOur findings did not show any significant association between rewarming rate and mortality, selected complications or abnormal neurologic exam suggestive of cerebral palsy. However, further prospective studies with strong methodological approach are required to provide conclusive evidence on this topic.

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“…The prevention of secondary injury in some neonates by using TH may have translated into improved neurodevelopmental outcomes. A better identification of the candidates for TH, an earlier initiation of TH, and an improved standardized care during TH focusing on the restoration of homeostasis and neuroprevention [50][51][52] may help to explain the continued improvement of outcome over the years. Other reasons may include quality improvement initiatives, with the goal to improve the outcomes of neonates with hypoxic-ischemic encephalopathy [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Neonates with a 10-min Apgar Score of Zero: A Systematic Review and Meta-Analysis

et al. 2022

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Introduction: The Apgar score is a standardized method of assessing the primary adaptation and clinical status of a neonate after birth. Our objective was to systematically review and meta-analyze the survival and the survival without moderate-to-severe neurodevelopmental impairment (NDI) of neonates with a 10-min Apgar score of zero. Methods: Six electronic databases were searched for reports published until November 2021 of neonates with a 10-min Apgar score of zero. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case series/reports. Meta-analyses of the proportion of outcomes were conducted using a random-effects model for studies published after year 2000 and reporting >5 neonates. Meta-regression using the median year of the study period and subgroup analyses by treatment with therapeutic hypothermia and by gestational age were conducted. Results: Twenty-eight studies of 820 neonates with moderate risk of bias were included. Survival was 40% (95% confidence interval 30–50%, 16 studies, 646 neonates, I2 = 83%), and it increased by 2.3% per year (95% CI 1.3–3.2%, p < 0.001). Survival without moderate-to-severe NDI was 19% (95% confidence interval 11–27%, 13 studies, 211 neonates, I2 = 62%). Survival was higher for neonates who received therapeutic hypothermia and for those with a gestational age ≥32 weeks compared to <32 weeks. Conclusion: Approximately 2 in 5 neonates with a 10-min Apgar score of zero survived, and 1 in 5 survive without moderate-to-severe NDI survived. Survival has improved over the years, especially since the era of therapeutic hypothermia.

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Proposing a care practice bundle for neonatal encephalopathy during therapeutic hypothermia

Cited by 14 publications

References 163 publications

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

Rewarming rate of hypothermic neonates in a low-resource setting: a retrospective single-center study

Outcomes of Neonates with a 10-min Apgar Score of Zero: A Systematic Review and Meta-Analysis

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