Subscribe to RSS
DOI: 10.1055/s-0040-1702990
Identifying Ways to Fix Outcome Disparities among Outborns Needing Therapeutic Hypothermia
Funding This work and the development of the NeoCool iOS application were funded via a grant from the Hartwell Foundation.![](https://www.thieme-connect.de/media/ajp/2021S01/lookinside/thumbnails/10-1055-s-0040-1702990_190443-1.jpg)
Abstract
Objective This study examined patterns of care after birth in newborns treated with therapeutic hypothermia to identify remediable causes for the poorer outcomes observed in outborn infants.
Study Design This was a secondary analysis of 150 newborns (68 outborn) prospectively enrolled at our center in the Vermont Oxford Neonatal Encephalopathy Registry from January 2008 to October 2016.
Results The 5-minute Apgar's score and cord pH value did not differ, but cord blood gases were obtained far less frequently in outborns (p = 0.002). Outborns needed more chest compressions (p = 0.01) and epinephrine (p = 0.04), and had more brain injury on neuroimaging (p = 0.05). Outborns took longer to reach target hypothermia temperature (p < 0.0001).
Conclusion The lack of cord gas values and longer time to reach target temperature observed in the outborns are two observed differences in care that can be potentially remedied by providing education and resources at delivering hospitals in rapid identification of hypothermia candidates, though further research is needed to define the effects of such measures. Possible solutions are also discussed here.
Publication History
Received: 25 July 2019
Accepted: 19 January 2020
Article published online:
02 March 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; (01) CD003311
- 2 Eicher DJ, Wagner CL, Katikaneni LP. et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32 (01) 11-17
- 3 Natarajan G, Pappas A, Shankaran S. et al. Effect of inborn vs. outborn delivery on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy: secondary analyses of the NICHD whole-body cooling trial. Pediatr Res 2012; 72 (04) 414-419
- 4 Simbruner G, Mittal RA, Rohlmann F, Muche R. ; neo.nEURO.network Trial Participants. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126 (04) e771-e778
- 5 Jacobs SE, Morley CJ, Inder TE. et al; Infant Cooling Evaluation Collaboration. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165 (08) 692-700
- 6 Pfister RH, Bingham P, Edwards EM. et al. The Vermont Oxford Neonatal Encephalopathy Registry: rationale, methods, and initial results. BMC Pediatr 2012; 12: 84
- 7 Akula VP, Gould JB, Davis AS, Hackel A, Oehlert J, Van Meurs KP. Therapeutic hypothermia during neonatal transport: data from the California Perinatal Quality Care Collaborative (CPQCC) and California Perinatal Transport System (CPeTS) for 2010. J Perinatol 2013; 33 (03) 194-197
- 8 Iwata O, Iwata S, Thornton JS. et al. “Therapeutic time window” duration decreases with increasing severity of cerebral hypoxia-ischaemia under normothermia and delayed hypothermia in newborn piglets. Brain Res 2007; 1154: 173-180
- 9 Wassink G, Gunn ER, Drury PP, Bennet L, Gunn AJ. The mechanisms and treatment of asphyxial encephalopathy. Front Neurosci 2014; 8: 40
- 10 Gunn AJ, Gunn TR, de Haan HH, Williams CE, Gluckman PD. Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest 1997; 99 (02) 248-256
- 11 Thoresen M, Tooley J, Liu X. et al. Time is brain: starting therapeutic hypothermia within three hours after birth improves motor outcome in asphyxiated newborns. Neonatology 2013; 104 (03) 228-233
- 12 Akula VP, Joe P, Thusu K. et al. A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy. J Pediatr 2015; 166 (04) 856-861
- 13 California Perinatal Quality Care Collaborative. Early screening and identification of candidates for neonatal therapeutic hypothermia toolkit 2015. Accessed February 7, 2020 at: https://www.cpqcc.org/sites/default/files/FINAL%20HIE%20Toolkit_2-15-15%20California%20Perinatal%20Quality%20Care%20Collaborative.pdf