Standardized Evaluation of Cord Gases in Neonates at Risk for Hypoxic Ischemic Encephalopathy

Abstract

BACKGROUND: Umbilical-cord acidemia may indicate perinatal asphyxia and places a neonate at increased risk for hypoxic ischemic encephalopathy (HIE). Our specific aim was to develop a standardized clinical care pathway, ensuring timely identification and evaluation of neonates with umbilical-cord acidemia at risk for HIE. METHODS: A standardized clinical care pathway to screen inborn neonates ≥36 weeks with abnormal cord blood gases (a pH of ≤7.0 or base deficit of ≥10) for HIE was implemented in January 2016. Abnormal cord blood gases resulted in a direct notification from the laboratory to an on-call physician. Evaluation included a modified Sarnat examination, postnatal blood gas, and standardized documentation. The percentage of neonates in which physician notification, documented Sarnat examination, and postnatal blood gas occurred was examined for 6 months before and 35 months after implementation. RESULTS: Of 203 neonates with abnormal cord gases in the post–quality improvement (QI) period, physician notification occurred in 92%. In the post-QI period, 94% had a documented Sarnat examination, and 94% had postnatal blood gas, compared with 16% and 11%, respectively, of 87 neonates in the pre-QI period. In the post-QI period, of those evaluated, >96% were documented within 4 hours of birth. In the post-QI period, 15 (7.4%) neonates were cooled; 13 were in the NICU at time of identification, but 2 were identified in the newborn nursery and redirected to the NICU for cooling. CONCLUSIONS: A standardized screening pathway in neonates with umbilical-cord acidemia led to timely identification and evaluation of neonates at risk for HIE.

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

“…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].…”

“…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]. Clinicians also may have become reluc-Neonatology 2022;119:669-685 DOI: 10.1159/000525926 tant to discontinue resuscitation efforts considering their knowledge of reports of survivors and survivors without moderate-to-severe NDI.…”