Safety and Effectiveness of Whole Body Cooling Therapy for Neonatal Encephalopathy on Transport

McNellis, Emily; Fisher, Tyler; Kilbride, Howard W.

doi:10.1016/j.amj.2015.03.002

Cited by 9 publications

(7 citation statements)

References 25 publications

(35 reference statements)

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“…Overall, just under two-thirds of infants with HIE retrieved by the Wellington NeTS received timely initiation of TH. This figure is comparable to previously published reports on the efficacy of manual cooling during neonatal transport, and it highlights the limitation of this strategy to provide timely neuroprotection for a significant proportion of outborn infants with HIE [11, 17, 24, 25]. …”

Section: Discussionsupporting

confidence: 77%

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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Section: Discussionsupporting

confidence: 77%

Impact of Education on Hypothermia Delivery during Neonatal Transport

et al. 2019

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“…The one study compared active versus passive cooling and reported the proportion of newborn infants with a body temperature < 33.0°C, i.e. overcooling, on admission to a referral centre 40 . Compared were postnatal age (hours) on admission to a referral centre, time to achieve target temperature in the first hours after birth, and the proportion of newborn infants cooled within the first 6 h of life.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were tagged as awaiting classification 31–34 . In the final analysis, 14 studies involving 1098 newborn infants were included 35–48 . The PRISMA flow chart is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies 40,41 involving 112 newborn infants compared active versus passive cooling. Both were classified at critical risk of bias as shown in Tables 2 and 3 for primary and secondary outcomes, respectively.…”

Section: Effect Of Interventionsmentioning

confidence: 99%

“…overcooling, on admission to a referral centre. 40 Compared were postnatal age (hours) on admission to a referral centre, time to achieve target temperature in the first hours after birth, and the proportion of newborn infants cooled within the first 6 h of life. The other study reported the proportion of newborn infants with a body temperature between 33.0°C and 34.0°C during transport.…”

Section: Effect Of Interventionsmentioning

confidence: 99%

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Cooling strategies during neonatal transport for hypoxic‐ischaemic encephalopathy

et al. 2022

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Aim:We reviewed the literature on cooling methods during transport of newborn infants with hypoxic-ischaemic encephalopathy (HIE) born in a non-tertiary centre and transferred to a neonatal intensive care unit for therapeutic hypothermia. Methods:The electronic databases CENTRAL, MEDLINE, Embase, CINAHL, and Scopus were searched from inception up to 8 March 2022 for studies comparing cooling versus no cooling, active versus passive cooling, and servo-controlled versus non-servo-controlled cooling. Odds ratio and confidence of interval were calculated for dichotomous outcomes and mean difference and confidence interval for continuous outcomes. Results:The final analysis included 14 studies, 1 randomised and 13 non-randomised, involving 1098 newborn infants. Compared with the other cooling methods, servocontrolled active cooling was more likely to maintain body temperature within the target range of 33°C-34°C on arrival at a neonatal intensive care unit: odds ratio 13.58, 95% confidence interval 4.32-42.66, risk difference 0.33, 95% confidence interval 0.19-0.46; 224 participants; three studies; I 2 0%. The certainty of evidence was low. Only five studies reported mortality rates. Conclusion:Servo-controlled active cooling may be the preferred method during transport of newborn infants with HIE. A future area of focus should be long-term neurodevelopmental outcomes after servo-controlled active cooling.

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Neonatal Transport

O'Mahony¹,

Woodward²

2018

Avery's Diseases of the Newborn

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Safety and Effectiveness of Whole Body Cooling Therapy for Neonatal Encephalopathy on Transport

Cited by 9 publications

References 25 publications

Impact of Education on Hypothermia Delivery during Neonatal Transport

Impact of Education on Hypothermia Delivery during Neonatal Transport

Cooling strategies during neonatal transport for hypoxic‐ischaemic encephalopathy

Neonatal Transport

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