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Vega-del-Val C, Arnaez J, Ochoa-Sangrador C, Garrido-Barbero M, García-Alix A. Incidence of encephalopathy and comorbidity in infants with perinatal asphyxia: a comparative prospective cohort study. Front Pediatr 2024; 12:1363576. [PMID: 38601274 PMCID: PMC11004398 DOI: 10.3389/fped.2024.1363576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background Programs that aim to improve the detection hypoxic-ischemic encephalopathy (HIE) should establish which neonates suffering from perinatal asphyxia need to be monitored within the first 6 h of life. Method An observational prospective cohort study of infants with gestational age ≥35 weeks, and above 1,800g, were included according to their arterial cord pH value (ApH): ≤7.00 vs. 7.01-7.10. Data was collected including obstetrical history, as well as neonatal comorbidities, including the presence of HIE, that happened within 6 h of life. A standardized neurological exam was performed at discharge. Results There were 9,537 births; 176 infants with ApH 7.01-7.10 and 117 infants with ApH ≤7.00. All 9 cases with moderate-to-severe HIE occurred among infants with ApH ≤7.00. The incidence of global and moderate-severe HIE was 3/1,000 and 1/1,000 births, respectively. Outcome at discharge (abnormal exam or death) showed an OR 12.03 (95% CI 1.53, 94.96) in infants with ApH ≤7.00 compared to ApH 7.01-7.10 cohort. Ventilation support was 5.1 times (95% CI 2.87, 9.03) more likely to be needed by those with cord ApH ≤7.00 compared to those with ApH 7.01-7.10, as well as hypoglycemia (37% vs. 25%; p = 0.026). In 55%, hypoglycemia occurred despite oral and/or intravenous glucose administration had been already initiated. Conclusions Cord pH 7.00 might be a safe pH cut-off point when developing protocols to monitor infants born with acidemia in order to identify infants with moderate or severe HIE early on. There is non-negligible comorbidity in the ApH ≤7.00 cohort, but also in the 7.01-7.10 cohort.
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Affiliation(s)
| | - Juan Arnaez
- Neonatology Unit, Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology, Nene Foundation, Madrid, Spain
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Florham Park, NJ, United States
| | - Carlos Ochoa-Sangrador
- Department of Investigation Unit, Hospital Virgen de la Concha, Zamora, Spain
- Ciencias de la Salud, Escuela Universitaria de Enfermería, Zamora, Spain
| | | | - Alfredo García-Alix
- Neonatal Neurology, Nene Foundation, Madrid, Spain
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Florham Park, NJ, United States
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2
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Okulu E, Hirfanoglu IM, Satar M, Erdeve O, Koc E, Ozlu F, Gokce M, Armangil D, Tunc G, Demirel N, Unal S, Ozdemir R, Deveci MF, Akar M, Demirel MK, Çetinkaya M, Buker HSC, Karagöl BS, Yaprak D, Akcan AB, Anik A, Narter F, Arayici S, Yildirim E, Akin IM, Sahin O, Ozdemir OEB, Ovali F, Akin MA, Celik Y, Orman A, Uslu S, Ozkan H, Koksal N, Tastekin A, Gunduz M, Arisoy AE, Gurpinar R, Ors R, Altunhan H, Kececi R, Yildizdas HY, Terek D, Ates M, Kader S, Mutlu M, Çelik K, Yucesoy E, Mert MK, Gulasi S, Kucuktasci K, Arman D, Hekimoglu B, Gultekin ND, Celik HT, Kahvecioglu D, Akyildiz C, Taşkın E, Ciftdemir NA, Uygun SS, Kaya TB, Akdag A, Yilmaz A. An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy. PLoS One 2023; 18:e0295759. [PMID: 38096201 PMCID: PMC10721008 DOI: 10.1371/journal.pone.0295759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. METHODS The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. RESULTS The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HİE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p<0.001). No significant difference in mortality and abnormal MRI results was found according to the time of TH initiation (<3 h, 3-6 h and >6 h) (p>0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). CONCLUSION The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether <3 or 3-6 h, did not result in lower occurrences of brain lesions on MRI or mortality. An increasing number of infants with mild HIE and late preterm infants with HIE are receiving TH; however, the indications for TH require further clarification. Longer follow-up studies are necessary for this vulnerable population.
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Affiliation(s)
- Emel Okulu
- Ankara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Ibrahim Murat Hirfanoglu
- Gazi University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Mehmet Satar
- Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana, Türkiye
| | - Omer Erdeve
- Ankara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Esin Koc
- Gazi University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Ferda Ozlu
- Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana, Türkiye
- Department of Neonatology, Seyhan State Hospital, Adana, Türkiye
| | - Mahmut Gokce
- Department of Neonatology, Seyhan State Hospital, Adana, Türkiye
| | - Didem Armangil
- Department of Pediatrics, Neonatal Intensive Care Unit, Koru Hospital, Ankara, Türkiye
| | - Gaffari Tunc
- Cumhuriyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Sivas, Türkiye
| | - Nihal Demirel
- Yildirim Beyazit University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
- Department of Neonatology, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Türkiye
| | - Sezin Unal
- Department of Neonatology, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Türkiye
| | - Ramazan Ozdemir
- Inonu University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Malatya, Türkiye
| | - Mehmet Fatih Deveci
- Inonu University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Malatya, Türkiye
| | - Melek Akar
- Department of Neonatology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir Türkiye
| | - Melike Kefeli Demirel
- Department of Neonatology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir Türkiye
| | - Merih Çetinkaya
- Department of Neonatology, University of Health Sciences, Basaksehir Çam and Sakura City Hospital, Istanbul, Türkiye
| | - Halime Sema Can Buker
- Department of Neonatology, University of Health Sciences, Basaksehir Çam and Sakura City Hospital, Istanbul, Türkiye
| | - Belma Saygılı Karagöl
- Gulhane Faculty of Medicine, Department of Pediatrics, Division of Neonatology, University of Health Sciences, Ankara, Türkiye
| | - Deniz Yaprak
- Gulhane Faculty of Medicine, Department of Pediatrics, Division of Neonatology, University of Health Sciences, Ankara, Türkiye
| | - Abdullah Barıs Akcan
- Adnan Menderes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Aydin, Türkiye
| | - Ayse Anik
- Adnan Menderes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Aydin, Türkiye
| | - Fatma Narter
- Department of Neonatology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
| | - Sema Arayici
- Department of Neonatology, Eskisehir State Hospital, Eskisehir, Türkiye
| | - Egemen Yildirim
- Department of Neonatology, Eskisehir State Hospital, Eskisehir, Türkiye
| | - Ilke Mungan Akin
- Department of Neonatology, University of Health Sciences, Umraniye Training and Research Hospital Istanbul, Istanbul, Türkiye
| | - Ozlem Sahin
- Department of Neonatology, University of Health Sciences, Umraniye Training and Research Hospital Istanbul, Istanbul, Türkiye
| | - Ozgul Emel Bulut Ozdemir
- Medeniyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Fahri Ovali
- Medeniyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Mustafa Ali Akin
- Ondokuz Mayis University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Samsun, Türkiye
| | - Yalcin Celik
- Mersin University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Mersin, Türkiye
| | - Aysen Orman
- Mersin University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Mersin, Türkiye
| | - Sinan Uslu
- Department of Neonatology, University of Health Sciences, Sisli Etfal Hamidiye Training and Research Hospital, Istanbul, Türkiye
| | - Hilal Ozkan
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Türkiye
| | - Nilgun Koksal
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Türkiye
| | - Ayhan Tastekin
- Medipol University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Mehmet Gunduz
- Medipol University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Ayse Engin Arisoy
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kocaeli, Türkiye
| | - Resat Gurpinar
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kocaeli, Türkiye
| | - Rahmi Ors
- Department of Pediatrics, Neonatal Intensive Care Unit, Ozel Medova Hospital, Konya, Türkiye
| | - Huseyin Altunhan
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Konya, Türkiye
| | - Ramazan Kececi
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Konya, Türkiye
| | - Hacer Yapicioglu Yildizdas
- Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana, Türkiye
| | - Demet Terek
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir, Türkiye
| | - Mehmet Ates
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir, Türkiye
| | - Sebnem Kader
- Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Trabzon, Türkiye
| | - Mehmet Mutlu
- Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Trabzon, Türkiye
| | - Kıymet Çelik
- Akdeniz University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Antalya, Türkiye
| | - Ebru Yucesoy
- Harran University Faculty of Medicine, Department of Pediatrics Division of Neonatology, Sanliurfa, Türkiye
| | | | - Selvi Gulasi
- Department of Neonatology, University of Health Sciences, Adana, Türkiye
| | - Kazım Kucuktasci
- Adana City Training and Research Hospital, Department of Pediatrics, Neonatal Intensive Care Unit, Ozel Saglik Hospital, Denizli, Türkiye
| | - Didem Arman
- Department of Neonatology, Istanbul Training and Research Hospital, Istanbul, Türkiye
| | - Berna Hekimoglu
- Department of Neonatology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Türkiye
| | - Nazlı Dilay Gultekin
- Department of Neonatology, Van Regional Training and Research Hospital, Van, Türkiye
| | - Hasan Tolga Celik
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Dilek Kahvecioglu
- Department of Neonatology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Can Akyildiz
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir, Türkiye
| | - Erdal Taşkın
- Fırat University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Elazıg, Türkiye
| | - Nukhet Aladag Ciftdemir
- Trakya University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Edirne, Türkiye
| | - Saime Sundus Uygun
- Necmettin Erbakan University Selcuk Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Konya, Türkiye
| | - Tugba Barsan Kaya
- Osmangazi University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Eskisehir, Türkiye
| | - Arzu Akdag
- Department of Neonatology, University of Health Sciences, Yuksek Ihtisas Teaching Hospital, Bursa, Türkiye
| | - Aslan Yilmaz
- Cerrahpasa University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
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Birkenmaier A, Adams M, Kleber M, Schwendener Scholl K, Rathke V, Hagmann C, Brotschi B, Grass B. Increase in Standardized Management of Neonates with Hypoxic-Ischemic Encephalopathy Since Implementation of a Patient Register. Ther Hypothermia Temp Manag 2023; 13:175-183. [PMID: 36811496 DOI: 10.1089/ther.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
The Swiss National Asphyxia and Cooling Register was implemented in 2011. This study assessed quality indicators of the cooling process and (short-term) outcomes of neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) longitudinally over time in Switzerland. This is a multicenter national retrospective cohort study of prospectively collected register data. Quality indicators were defined for longitudinal comparison (2011-2014 vs. 2015-2018) of processes of TH and (short-term) outcomes of neonates with moderate-to-severe HIE. Five hundred seventy neonates receiving TH in 10 Swiss cooling centers were included (2011-2018). Four hundred forty-nine (449/570; 78.8%) neonates with moderate-to-severe HIE received TH according to the Swiss National Asphyxia and Cooling Register Protocol. Quality indicators of processes of TH improved in 2015-2018 (compared with 2011-2014): less passive cooling (p = 0.013), shorter time to reach target temperature (p = 0.002), and less over- or undercooling (p < 0.001). In 2015-2018, adherence to performing a cranial magnetic resonance imaging after rewarming improved (p < 0.001), whereas less cranial ultrasounds were performed on admission (p = 0.012). With regard to quality indicators of short-term outcomes, persistent pulmonary hypertension of the neonate was reduced (p = 0.003), and there was a trend toward less coagulopathy (p = 0.063) in 2015-2018. There was no statistically significant change in the remaining processes and outcomes. The Swiss National Asphyxia and Cooling Register is well implemented with good overall adherence to the treatment protocol. Management of TH improved longitudinally. Continuous reevaluation of register data is desirable for quality assessment, benchmarking, and maintaining international evidence-based quality standards.
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Affiliation(s)
- André Birkenmaier
- University of Zurich, Faculty of Medicine, Department of Neonatology and Pediatric Intensive Care, Children's Hospital St. Gallen, Neonatal and Pediatric Intensive Care Unit, St. Gallen, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Kleber
- Clinic of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Verena Rathke
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beate Grass
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Vega-Del-Val C, Arnaez J, Caserío S, Gutiérrez EP, Castañón L, Benito M, Garcia-Alix A. Adherence to hypothermia guidelines in newborns with hypoxic-ischemic encephalopathy. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:30-39. [PMID: 35729059 DOI: 10.1016/j.anpede.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/16/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION We do not have population data in Spain on the application of therapeutic hypothermia (TH). The objective was to examine adherence to management standards during TH of infants with hypoxic-ischemic encephalopathy (HIE). METHOD Multicenter observational cohort study from the beginning of TH (year 2010) in 5 hospitals in a Spanish region, until year 2019. RESULTS 133 patients were recruited, 72% diagnosed with moderate HIE and the rest of them with severe HIE. In 84% of infants, passive hypothermia was started at birth. Active TH was started at a median age of 5 h of life (IQR 3.3; 6.3), although the central targeted temperature (33-34 °C) was reached at a median age of 3.5 h (IQR 1; 6). Those born extramural, initiated active TH 3.3 h on average later than those born intramural, but without differences in the age at which the targeted temperature was reached. Sedoanalgesia was used in 97%. 100% were monitored with amplitude-integrated EEG and 59% with cerebral oxymetry. MRI was performed in 94% with moderate HIE vs. 65% with severe; P < .001. Neuron-specific enolase in cerebrospinal fluid was determined in 42%. The average duration of rewarming was median 10 h (IQR 8; 12), with no differences depending on the degree of HIE (P = .57). CONCLUSIONS The implementation of TH successfully met the standards. However, aspects of care that could be improved were detected. Auditing newborn care with HIE is crucial to achieving programs with a high quality of care in each region.
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Affiliation(s)
| | - Juan Arnaez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Burgos, Burgos, Spain; Neurología Neonatal, Fundación NeNe, Madrid, Spain.
| | - Sonia Caserío
- Departamento de Pediatría (Neonatología), Hospital Universitario Río Hortega, Valladolid, Spain
| | - Elena Pilar Gutiérrez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Leticia Castañón
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de León, León, Spain
| | - Marta Benito
- Departamento de Pediatría (Neonatología), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Benz LD, Bode PK, Brandt S, Grass B, Hagmann C, Liamlahi R, Frey B, Held U, Brotschi B. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy - an 11-year single-center experience. J Perinat Med 2022; 50:343-350. [PMID: 34670032 DOI: 10.1515/jpm-2020-0583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although neonates with moderate to severe hypoxic ischemic encephalopathy (HIE) receive therapeutic hypothermia (TH), 40-50% die or have significant neurological disability. The aim of this study is to analyse the association of placental pathology and neurodevelopmental outcome in cooled neonates with HIE at 18-24 months of age. METHODS Retrospective analysis of prospectively collected data on 120 neonates registered in the Swiss National Asphyxia and Cooling Register born between 2007 and 2017. This descriptive study examines the frequency and range of pathologic findings in placentas of neonates with HIE. Placenta pathology was available of 69/120 neonates, whose results are summarized as placental findings. As neonates with HIE staged Sarnat score 1 (21/69) did not routinely undergo follow-up assessments and of six neonates staged Sarnat Score 2/3 no follow-up assessments were available, 42/48 (88%) neonates remain to assess the association between placental findings and outcome. RESULTS Of the 42/48 (88%) neonates with available follow up 29% (12/42) neonates died. Major placenta abnormalities occurred in 48% (20/42). Major placenta abnormality was neither associated with outcome at 18-24 months of age (OR 1.75 [95% CI 0.50-6.36, p=0.381]), nor with death by 2 years of age (OR 1.96 [95% CI 0.53-7.78, p=0.320]). CONCLUSIONS In this study cohort there could not be shown an association between the placenta findings and the neurodevelopmental outcome at 18-24 months of age.
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Affiliation(s)
- Laura D Benz
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Peter K Bode
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Simone Brandt
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Beate Grass
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Rabia Liamlahi
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernhard Frey
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
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Adams M, Brotschi B, Birkenmaier A, Schwendener K, Rathke V, Kleber M, Hagmann C. Process variations between Swiss units treating neonates with hypoxic-ischemic encephalopathy and their effect on short-term outcome. J Perinatol 2021; 41:2804-2812. [PMID: 34290374 PMCID: PMC8752440 DOI: 10.1038/s41372-021-01156-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/28/2021] [Accepted: 07/09/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare therapeutic hypothermia (TH) treatment of term and near-term neonates with hypoxic-ischemic encephalopathy (HIE) between neonatal units. STUDY DESIGN Population-based, retrospective analysis of TH initiation and maintenance, and of diagnostic imaging. The comparison between units was based on crude data analysis, indirect standardization, and adjusted logistic regression. RESULTS TH was provided to 570 neonates with HIE between 2011 and 2018 in 10 Swiss units. We excluded 121 off-protocol cooled neonates to avoid selection bias. Of the remaining 449 neonates, the outcome was favorable to international benchmarks, but there were large unit-to-unit variations in baseline perinatal data and TH management. A total of 5% neonates did not reach target temperature within 7 h (3-10% between units), and 29% experienced over- or undercooling (0-38%). CONCLUSION Although the neonates had favorable short-term outcomes, areas for improvement remain for Swiss units in both process and outcome measures.
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Affiliation(s)
- Mark Adams
- Newborn Research, Department of Neonatology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Barbara Brotschi
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital Zurich, Zurich, Switzerland
| | - André Birkenmaier
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital St. Gallen, Neonatal and Pediatric Intensive Care Unit, St. Gallen, Switzerland
| | - Katharina Schwendener
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, Spitalstrasse, Lucerne, Switzerland
| | - Verena Rathke
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital Zurich, Zurich, Switzerland
| | - Michael Kleber
- Clinic of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Cornelia Hagmann
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital Zurich, Zurich, Switzerland
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7
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Vega-Del-Val C, Arnaez J, Caserío S, Gutiérrez EP, Castañón L, Benito M, Garcia-Alix A. [Adherence to hypothermia guidelines in newborns with hypoxic-ischemic encephalopathy]. An Pediatr (Barc) 2021; 97:S1695-4033(21)00245-9. [PMID: 34535415 DOI: 10.1016/j.anpedi.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We do not have population data in Spain on the application of therapeutic hypothermia (TH). The objective was to examine adherence to management standards during TH of infants with hypoxic-ischemic encephalopathy (HIE). METHOD Multicenter observational cohort study from the beginning of TH (year 2010) in 5 hospitals in a Spanish region, until year 2019. RESULTS 133 patients were recruited, 72% diagnosed with moderate HIE and the rest of them with severe HIE. In 84% of infants, passive hypothermia was started at birth. Active TH was started at a median age of 5hours of life (IQR: 3.3-6.3), although the central targeted temperature (33-34°C) was reached at a median age of 3.5hours (IQR: 1-6). Those born extramural, initiated active TH 3.3hours on average later than those born intramural, but without differences in the age at which the targeted temperature was reached. Sedoanalgesia was used in 97%. The 100% were monitored with amplitude-integrated EEG and 59% with cerebral oxymetry. MRI was performed in 94% with moderate HIE vs. 65% with severe; P<.001. Neuron-specific enolase in cerebrospinal fluid was determined in 42%. The average duration of rewarming was median 10hours (IQR: 8-12), with no differences depending on the degree of HIE (P=.57). CONCLUSIONS The implementation of TH successfully met the standards. However, aspects of care that could be improved were detected. Auditing newborn care with HIE is crucial to achieving programs with a high quality of care in each region.
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Affiliation(s)
- Cristina Vega-Del-Val
- Unidad de Neonatología, Complejo Asistencial Universitario de Burgos, Burgos, España
| | - Juan Arnaez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Burgos, Burgos, España; Neurología Neonatal, Fundación NeNe, Madrid, España.
| | - Sonia Caserío
- Departamento de Pediatría (Neonatología), Hospital Universitario Río Hortega, Valladolid, España
| | - Elena Pilar Gutiérrez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Leticia Castañón
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de León, León, España
| | - Marta Benito
- Departamento de Pediatría (Neonatología), Hospital Clínico Universitario de Valladolid, Valladolid, España
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Grass B, Scheidegger S, Latal B, Hagmann C, Held U, Brotschi B. Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18-24 months. J Perinat Med 2020; 48:296-303. [PMID: 32069247 DOI: 10.1515/jpm-2019-0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/22/2020] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18-24 months. Methods This is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18-24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up. Results One hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18-24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051-0.271] for an unfavorable outcome at 18-24 months. Conclusion Short-term neurological improvement predicts neurodevelopmental outcome at 18-24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.
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Affiliation(s)
- Beate Grass
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Simone Scheidegger
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
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Scheidegger S, Held U, Grass B, Latal B, Hagmann C, Brotschi B. Association of perinatal risk factors with neurological outcome in neonates with hypoxic ischemic encephalopathy. J Matern Fetal Neonatal Med 2019; 34:1020-1027. [PMID: 31117854 DOI: 10.1080/14767058.2019.1623196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Neonates exposed to perinatal insults typically present with hypoxic ischemic encephalopathy (HIE). The aim of our study was to analyze the association between known risk factors for HIE and the severity of encephalopathy after birth and neurological outcome in neonates during the first 4 d of life. METHODS Retrospective cohort study including 174 neonates registered between 2011 and 2013 in the National Asphyxia and Cooling Register of Switzerland. RESULTS None of the studied perinatal risk factors is associated with the severity of encephalopathy after birth. Fetal distress during labor (OR, 2.06; 95% CI, 1.02-4.25, p = .049) and neonatal head circumference (HC) above 10th percentile (p10) at birth (OR, 1.33; 95% CI, 1.05-1.69, p = .02) were associated with neurological benefit in the univariate analysis. Fetal distress on maternal admission for delivery was the only risk factor for neurological harm in the univariate (OR, 0.26; 95% CI, 0.12-0.57, p < .01) and the multivariate analysis (OR, 0.15; 95% CI, 0.04-0.67, p = .013). We identified two different patient scenarios: the probability for neurological benefit during the first 4 d of life was only 20% in neonates with the combination of all the following risk factors (gestational age >41 weeks, chorioamnionitis, fetal distress on maternal admission for delivery, fetal distress during labor, sentinel events during labor, HC below 10th percentile), whereas in the absence of these risk factors the probability for neurological benefit increased to 80%. CONCLUSIONS We identified a constellation of risk factors that influence neurological outcome in neonates with HIE during the first 4 d of life. These findings may help clinicians to counsel parents during the early neonatal period. (ClinicalTrials.gov NCT02800018).
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Affiliation(s)
- S Scheidegger
- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
| | - U Held
- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
| | - B Grass
- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
| | - B Latal
- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
| | - C Hagmann
- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
| | - B Brotschi
- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
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- Department of Pediatric and Neonatal Intensive Care, University Childrens' Hospital Zurich, Zurich, Switzerland
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buchiboyina A, Ma E, Yip A, Wagh D, Tan J, McMichael J, Bulsara M, Rao S. Servo controlled versus manual cooling methods in neonates with hypoxic ischemic encephalopathy. Early Hum Dev 2017; 112:35-41. [PMID: 28686927 DOI: 10.1016/j.earlhumdev.2017.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Therapeutic hypothermia is known to improve outcomes in neonates with hypoxic ischemic encephalopathy (HIE). There are no studies that have compared servo controlled cooling (SCC) versus manually controlled cooling (MCC) methods in HIE. AIM To compare the outcomes of SCC versus MCC in neonates with HIE. METHODS AND OUTCOME MEASURES Between Jan 2008 and May 2011, MCC with cool-gel packs was used to achieve rectal temperatures of 33.5 to 34.5°C in our units. Subsequently, we changed to SCC to achieve rectal temperatures of 33 to 34°C. 105 neonates received SCC whereas 95 received MCC. Retrospective study with multivariate analysis was conducted comparing thermoregulation (primary outcome) and neurodevelopmental outcomes of SCC versus MCC. RESULTS In the SCC group, 72.3% had stage 2 or 3 HIE versus 77.9% in the MCC. The remaining had stage 1, but attending neonatologists decided to provide cooling. Prescribed rectal temperatures were achieved in 80.5% (5768/7168) instances in SCC versus 72.9% (4449/6108) in MCC (p<0.0001). There were no significant differences in the incidence of 'death or moderate-severe disability' [SCC 26/85 vs MCC 26/87, adjusted odds ratio: 1.29, 95% CI: 0.48, 3.42; p=0.614]. The results were similar after excluding stage 1 HIE [SCC 25/66 vs MCC 26/69, adjusted odds ratio: 1.01, 95% CI: 0.50, 2.02; p=0.981]. CONCLUSIONS SCC resulted in better thermoregulation in neonates undergoing therapeutic hypothermia. There were no significant differences in neurodevelopmental outcomes, but the study was underpowered to answer this. Randomized trials are needed to fine-tune various aspects of TH in neonates with HIE.
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Affiliation(s)
- Ashok Buchiboyina
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia; Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Eric Ma
- University of Western Australia, Crawley, Western Australia, Australia
| | - Andrew Yip
- University of Western Australia, Crawley, Western Australia, Australia
| | - Deepika Wagh
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia; Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Jason Tan
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia; Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Judy McMichael
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia; Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Max Bulsara
- University of Notre Dame, Fremantle, Western Australia, Australia
| | - Shripada Rao
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia; Princess Margaret Hospital, Subiaco, Western Australia, Australia; Centre for Neonatal Research and Education, Subiaco, Western Australia, Australia.
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Brotschi B, Gunny R, Rethmann C, Held U, Latal B, Hagmann C. Relationship between temperature variability and brain injury on magnetic resonance imaging in cooled newborn infants after perinatal asphyxia. J Perinatol 2017; 37:1032-1037. [PMID: 28617423 DOI: 10.1038/jp.2017.96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/07/2017] [Accepted: 05/15/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of the study was whether temperature management during therapeutic hypothermia correlates with the severity of brain injury assessed on magnetic resonance imaging in term infants with hypoxic-ischemic encephalopathy. STUDY DESIGN Prospectively collected register data from the National Asphyxia and Cooling Register of Switzerland were analyzed. RESULT Fifty-five newborn infants were cooled for 72 h with a target temperature range of 33 to 34 °C. Individual temperature variability (odds ratio (OR) 40.17 (95% confidence interval (CI) 1.37 to 1037.67)) and percentage of temperatures within the target range (OR 0.95 (95% CI 0.90 to 0.98)) were associated with the severity of brain injury seen on magnetic resonance imaging (MRI). Neither the percentage of measured temperatures above (OR 1.08 (95% CI 0.96 to 1.21)) nor below (OR 0.99 (95% CI 0.92 to 1.07) the target range was associated with the severity of brain injury seen on MRI. CONCLUSION In a national perinatal asphyxia cohort, temperature variability and percentage of temperatures within the target temperature range were associated with the severity of brain injury.
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Affiliation(s)
- B Brotschi
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - R Gunny
- Department of Pediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C Rethmann
- Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - U Held
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University Hospital Zurich, Zurich, Switzerland
| | - B Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - C Hagmann
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
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Arnaez J, García-Alix A, Arca G, Caserío S, Valverde E, Moral MT, Benavente-Fernández I, Lubián-López S. Population-Based Study of the National Implementation of Therapeutic Hypothermia in Infants with Hypoxic-Ischemic Encephalopathy. Ther Hypothermia Temp Manag 2017; 8:24-29. [PMID: 28800288 DOI: 10.1089/ther.2017.0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Data on the incidence of hypoxic-ischemic encephalopathy (HIE) in the first 6 hours of life together with the implementation of therapeutic hypothermia (TH) are relevant to delineate actions to achieve the lowest rates of neonatal mortality, morbidity, and long-term impact on health associated with HIE. This is population-based national survey study, including newborns ≥35 weeks of gestation with moderate-to-severe HIE from all level III neonatal care units, to provide the incidence of HIE for the period 2012-2013, and the implementation of TH up to June 2015 in Spain. Incidence rate was 0.77 per 1000 live births (95% confidence interval 0.72-0.83). By June 2015, 63% (57/90) of the units had implemented TH; 95% of them performed servo-controlled whole-body TH. For the 2-year period, 86% of the newborns diagnosed with moderate-to-severe HIE received TH. Active TH increased in use from 78% in 2012 to 85% in 2013 (p = 0.01). The main reasons for not cooling were a delay in the diagnosis (31/682) and the fact that the treatment was not offered (20/682). Interhospital patient transfer was performed using passive hypothermia, by appropriately trained personnel in 61% of centers. Eighteen percent of newborns with moderate or severe HIE died, without significant differences between the 2 years. Up-to-date knowledge of the national coverage of neonatal care of infants with HIE in developed countries is a prerequisite to reducing the load of HIE in this area and to facilitating coordinated, eliminate investigation.
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Affiliation(s)
- Juan Arnaez
- 1 Unidad de Neonatología, Hospital Universitario de Burgos , Burgos, España, Fundación NeNe, España
| | - Alfredo García-Alix
- 2 Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu , Universitat de Barcelona, Barcelona, España, Fundación NeNe, España
| | - Gemma Arca
- 3 Unidad de Neonatología, Hospital Universitario Clinic (Sede Maternitat) , Barcelona, España, Fundación NeNe, España
| | - Sonia Caserío
- 4 Unidad de Neonatología, Hospital Universitario Río Hortega , Valladolid, España, Fundación NeNe, España
| | - Eva Valverde
- 5 Servicio de Neonatología. Hospital Universitario La Paz , Madrid, España, Fundación NeNe, España
| | - M Teresa Moral
- 6 Servicio de Neonatología, Hospital Universitario 12 de Octubre , Madrid, España, Fundación NeNe, España
| | | | - Simón Lubián-López
- 7 Unidad de Neonatología, Hospital Universitario Puerta del Mar , Cádiz, España, Fundación NeNe, España
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. [Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain]. An Pediatr (Barc) 2017; 89:12-23. [PMID: 28764944 DOI: 10.1016/j.anpedi.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015. RESULTS All (90) contacted hospitals participated. HIE incidence rate was 0.77/1000 live newborns (95% CI 0.72 - 0.83). During 2012-2013, 86% of the newborns diagnosed with moderate-severe HIE received TH (active or passive). Active TH was increasingly used, from 78% in 2012 to 85% in 2013 (P=.01). Of the 14% that did not receive TH, it was mainly due to a delay in the diagnosis or inter-hospital transfer, and to the fact that the treatment was not offered. More than half (57%) were born in hospitals where TH was not provided, and passive hypothermia was used for inter-hospital patient transfer, and in 39% of the cases by inappropriately trained personnel. By June 2015, 57 out of 90 centres had implemented TH, of which 54 performed whole-body TH (using servo-controlled devices). The geographical distribution of centres with active TH, and the number of newborn that received TH, was heterogeneous. CONCLUSIONS The incidence of moderate-severe HIE is homogeneous across Spanish territory. Significant progress is being made in the implementation of TH, however it is necessary to increase the availability of active TH between Autonomous Communities, to improve early diagnosis, and to guarantee high quality patient transfer to referral centres.
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Affiliation(s)
- Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, España; Fundación NeNe, Madrid, España.
| | - Alfredo García-Alix
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Universitat de Barcelona, Barcelona, España; Fundación NeNe, Madrid, España
| | - Gemma Arca
- Unidad de Neonatología, Hospital Universitario Clínic (Sede Maternitat), Barcelona, España; Fundación NeNe, Madrid, España
| | - Eva Valverde
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España; Fundación NeNe, Madrid, España
| | - Sonia Caserío
- Unidad de Neonatología, Hospital Universitario Río Hortega, Valladolid, España; Fundación NeNe, Madrid, España
| | - M Teresa Moral
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España; Fundación NeNe, Madrid, España
| | - Isabel Benavente-Fernández
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
| | - Simón Lubián-López
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
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Endrich O, Rimle C, Zwahlen M, Triep K, Raio L, Nelle M. Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015. PLoS One 2017; 12:e0170691. [PMID: 28118380 PMCID: PMC5261744 DOI: 10.1371/journal.pone.0170691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 01/09/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The ICD-10 categories of the diagnosis "perinatal asphyxia" are defined by clinical signs and a 1-minute Apgar score value. However, the modern conception is more complex and considers metabolic values related to the clinical state. A lack of consistency between the former clinical and the latter encoded diagnosis poses questions over the validity of the data. Our aim was to establish a refined classification which is able to distinctly separate cases according to clinical criteria and financial resource consumption. The hypothesis of the study is that outdated ICD-10 definitions result in differences between the encoded diagnosis asphyxia and the medical diagnosis referring to the clinical context. METHODS Routinely collected health data (encoding and financial data) of the University Hospital of Bern were used. The study population was chosen by selected ICD codes, the encoded and the clinical diagnosis were analyzed and each case was reevaluated. The new method categorizes the diagnoses of perinatal asphyxia into the following groups: mild, moderate and severe asphyxia, metabolic acidosis and normal clinical findings. The differences of total costs per case were determined by using one-way analysis of variance. RESULTS The study population included 622 cases (P20 "intrauterine hypoxia" 399, P21 "birth asphyxia" 233). By applying the new method, the diagnosis asphyxia could be ruled out with a high probability in 47% of cases and the variance of case related costs (one-way ANOVA: F (5, 616) = 55.84, p < 0.001, multiple R-squared = 0.312, p < 0.001) could be best explained. The classification of the severity of asphyxia could clearly be linked to the complexity of cases. CONCLUSION The refined coding method provides clearly defined diagnoses groups and has the strongest effect on the distribution of costs. It improves the diagnosis accuracy of perinatal asphyxia concerning clinical practice, research and reimbursement.
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Affiliation(s)
- Olga Endrich
- Medical Directorate, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Carole Rimle
- Student at the Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karen Triep
- Medical Directorate, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Mathias Nelle
- Neonatology Division, Inselspital, University Hospital of Bern, Bern, Switzerland
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Horsch A, Jacobs I, Gilbert L, Favrod C, Schneider J, Morisod Harari M, Bickle Graz M. Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents. BMJ Paediatr Open 2017; 1:e000059. [PMID: 29637108 PMCID: PMC5862159 DOI: 10.1136/bmjpo-2017-000059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group. DESIGN Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale). RESULTS The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p<0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=-0.37 (95% CI -0.61 to -0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=-0.38 (95% CI -0.64 to -0.05)). CONCLUSIONS Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents.
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Affiliation(s)
- Antje Horsch
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Ingo Jacobs
- Department of Psychology, Sigmund Freud PrivatUniversität Berlin, Berlin, Germany
| | - Leah Gilbert
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Céline Favrod
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Juliane Schneider
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland.,Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mathilde Morisod Harari
- Department of Child and Adolescent Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Myriam Bickle Graz
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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