BACKGROUND: Therapeutic hypothermia (TH) is the first intervention to consistently show improved neurological outcomes in neonates with hypoxic ischemic encephalopathy (HIE). Since the recent introduction of TH for HIE in many centres, reviews of practices during the implementation of TH in Canada have not been published. OBJECTIVE: To determine if eligible neonates are being offered TH and to identify any barriers to the effective implementation of TH. METHODS: A retrospective review of neonates referred to a regional tertiary centre at a gestational age of 35 weeks or more with HIE was conducted. RESULTS: Among 41 neonates referred, 29 (71%) were eligible for TH; among eligible patients, five were moribund and excluded, and TH was initiated in 16 (67%) of the remaining 24. Reasons for not cooling in eight eligible patients included a delay in referral (n=5, median age at referral was 14 h) and a failure to recognize the severity of HIE (n=3). Among cooled patients, median times were the following: 116 min for age at referral; 80 min for time from referral to transport team arrival; and 358 min for age at initiation of cooling. Seven (44%) patients had cooling initiated after 6 h of age. CONCLUSION: A significant proportion of eligible patients were not offered TH, and in many cooled patients, initiation of cooling was delayed beyond the recommended 6 h. For eligible patients to benefit from TH, it is imperative that all birthing centres be made aware that TH is now widely available as an important treatment option, but also that TH is a time-sensitive therapy requiring rapid identification and referral. In the region studied, for eligible patients, referring hospitals should initiate passive cooling before arrival of the transport team. Referring hospitals should be prepared to provide early, yet safe initiation of passive cooling by having the appropriate equipment, and having staff trained in the use and monitoring of rectal temperatures.
BACKGROUND: Therapeutic hypothermia (TH) is the first intervention to consistently show improved neurological outcomes in neonates with hypoxic ischemicencephalopathy (HIE). Since the recent introduction of TH for HIE in many centres, reviews of practices during the implementation of TH in Canada have not been published. OBJECTIVE: To determine if eligible neonates are being offered TH and to identify any barriers to the effective implementation of TH. METHODS: A retrospective review of neonates referred to a regional tertiary centre at a gestational age of 35 weeks or more with HIE was conducted. RESULTS: Among 41 neonates referred, 29 (71%) were eligible for TH; among eligible patients, five were moribund and excluded, and TH was initiated in 16 (67%) of the remaining 24. Reasons for not cooling in eight eligible patients included a delay in referral (n=5, median age at referral was 14 h) and a failure to recognize the severity of HIE (n=3). Among cooled patients, median times were the following: 116 min for age at referral; 80 min for time from referral to transport team arrival; and 358 min for age at initiation of cooling. Seven (44%) patients had cooling initiated after 6 h of age. CONCLUSION: A significant proportion of eligible patients were not offered TH, and in many cooled patients, initiation of cooling was delayed beyond the recommended 6 h. For eligible patients to benefit from TH, it is imperative that all birthing centres be made aware that TH is now widely available as an important treatment option, but also that TH is a time-sensitive therapy requiring rapid identification and referral. In the region studied, for eligible patients, referring hospitals should initiate passive cooling before arrival of the transport team. Referring hospitals should be prepared to provide early, yet safe initiation of passive cooling by having the appropriate equipment, and having staff trained in the use and monitoring of rectal temperatures.
Authors: Seetha Shankaran; Abbot R Laptook; Richard A Ehrenkranz; Jon E Tyson; Scott A McDonald; Edward F Donovan; Avroy A Fanaroff; W Kenneth Poole; Linda L Wright; Rosemary D Higgins; Neil N Finer; Waldemar A Carlo; Shahnaz Duara; William Oh; C Michael Cotten; David K Stevenson; Barbara J Stoll; James A Lemons; Ronnie Guillet; Alan H Jobe Journal: N Engl J Med Date: 2005-10-13 Impact factor: 91.245
Authors: S A Zanelli; M Naylor; N Dobbins; M Quigg; H P Goodkin; J A Matsumoto; K D Fairchild Journal: J Perinatol Date: 2007-12-06 Impact factor: 2.521
Authors: Peter D Gluckman; John S Wyatt; Denis Azzopardi; Roberta Ballard; A David Edwards; Donna M Ferriero; Richard A Polin; Charlene M Robertson; Marianne Thoresen; Andrew Whitelaw; Alistair J Gunn Journal: Lancet Date: 2005 Feb 19-25 Impact factor: 79.321
Authors: Sophie Casey; Kate Goasdoue; Stephanie M Miller; Gary P Brennan; Gary Cowin; Adam G O'Mahony; Christopher Burke; Boubou Hallberg; Geraldine B Boylan; Aideen M Sullivan; David C Henshall; Gerard W O'Keeffe; Catherine Mooney; Tracey Bjorkman; Deirdre M Murray Journal: Mol Neurobiol Date: 2020-07-27 Impact factor: 5.682