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Selvanathan T, Miller SP. Challenging Current Perspectives of Neonatal Hypoxic-Ischemic Encephalopathy: Is Encephalopathy Necessary? Neurology 2024; 102:e209212. [PMID: 38422466 DOI: 10.1212/wnl.0000000000209212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/19/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Thiviya Selvanathan
- From the Department of Pediatrics (T.S., S.P.M.), University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC; and Department of Pediatrics (T.S., S.P.M.), The Hospital for Sick Children, Toronto, ON, Canada
| | - Steven P Miller
- From the Department of Pediatrics (T.S., S.P.M.), University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC; and Department of Pediatrics (T.S., S.P.M.), The Hospital for Sick Children, Toronto, ON, Canada
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El-Dib M, El-Shibiny H, Walsh B, Cherkerzian S, Boulanger J, Bates SV, Culic I, Gupta M, Hansen A, Herzberg E, Joung K, Keohane C, Patrizi S, Soul JS, Inder T. Establishing a regional registry for neonatal encephalopathy: impact on identification of gaps in practice. Pediatr Res 2024; 95:213-222. [PMID: 37553453 DOI: 10.1038/s41390-023-02763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Neonatal encephalopathy (NE) continues to be a significant risk for death and disability. To address this risk, regional guidelines were developed with the support of a malpractice insurance patient safety organization. A NE registry was also established to include 14 centers representing around 50% of deliveries in the state of Massachusetts. The aim of this study was to identify areas of variation in practice that could benefit from quality improvement projects. METHODS This manuscript reports on the establishment of the registry and the primary findings to date. RESULTS From 2018 to 2020, 502 newborns with NE were evaluated for Therapeutic Hypothermia (TH), of which 246 (49%) received TH, representing a mean of 2.91 per 1000 live births. The study reports on prenatal characteristics, delivery room resuscitation, TH eligibility screening, and post-natal management of newborns with NE who did and did not receive TH. CONCLUSIONS The registry has allowed for the identification of areas of variation in clinical practices, which have guided ongoing quality improvement projects. The authors advocate for the establishment of local and regional registries to standardize and improve NE patient care. They have made the registry data collection tools freely available for other centers to replicate this work. IMPACT Malpractice insurance companies can take an active role in supporting clinicians in establishing clinical practice guidelines and regional registries. Establishing a collaborative regional neonatal encephalopathy (NE) registry is feasible. Data Collection tools for a NE registry have been made publicly available to be adopted and replicated by other groups. Establishing a regional NE registry allowed for the identification of gaps in knowledge, variations in practice, and the opportunity to advance care through quality improvement projects.
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Affiliation(s)
- Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Hoda El-Shibiny
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Walsh
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Sara Cherkerzian
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jason Boulanger
- Department of Patient Safety, CRICO/Risk Management Foundation of the Harvard Medical Institutions, Boston, MA, USA
| | - Sara V Bates
- Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, Mass General Hospital for Children, Boston, MA, USA
| | - Ivana Culic
- Department of Neonatology, Beth Israel Hospital, Boston, MA, USA
- Department of Pediatrics, Beverley Hospital, Boston, MA, USA
| | - Munish Gupta
- Harvard Medical School, Boston, MA, USA
- Department of Neonatology, Beth Israel Hospital, Boston, MA, USA
| | - Anne Hansen
- Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Emily Herzberg
- Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, Mass General Hospital for Children, Boston, MA, USA
| | - Kyoung Joung
- Division of Newborn Medicine, Mass General Hospital for Children, Boston, MA, USA
- Department of Pediatrics, St. Elizabeth Medical Center, Brighton, MA, USA
| | - Carol Keohane
- Senior Vice President, Chief Quality and Safety Officer, South Shore Health, South Weymouth, MA, USA
| | - Silvia Patrizi
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Newton Wellesley Hospital, Wellesley, MA, USA
| | - Janet S Soul
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Terrie Inder
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Center for Neonatal Research, Children's Hospital of Orange County, Orange County, CA, USA
- University of California, Irvine - College of Medicine, Irvine, CA, USA
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