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Availability of active therapeutic hypothermia at birth for neonatal hypoxic ischaemic encephalopathy: a UK population study from 2011 to 2018

Mistry, Aarti; Shipley, Lara; Ojha, Shalini; Sharkey, Don

Availability of active therapeutic hypothermia at birth for neonatal hypoxic ischaemic encephalopathy: a UK population study from 2011 to 2018 Thumbnail


Authors

Aarti Mistry

Lara Shipley

SHALINI OJHA Shalini.Ojha@nottingham.ac.uk
Professor of Neonatal Medicine

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DON SHARKEY don.sharkey@nottingham.ac.uk
Professor of Neonatal Medicine and Technologies



Abstract

Objective: Therapeutic hypothermia (TH) commenced soon after birth for neonatal hypoxic ischaemic encephalopathy (HIE) improves survival and reduces neurodisability. Availability of active TH at the place of birth (Immediate-TH) in the UK is unknown. Design: Population-based observational study. Setting: UK maternity centres. Patients: 5 975 056 births from 2011 to 2018. Intervention methods: For each maternity centre, the year active Immediate-TH was available and the annual birth rates were established. Admission temperatures of infants with HIE transferred from non-tertiary centres with and without Immediate-TH were compared. Main outcome measures: Quantify the annual number of births with access to Immediate-TH. Secondary outcomes included temporal changes in Immediate-TH and admission temperatures for infants requiring transfer to tertiary centres. Results: In UK maternity centres, 75 of 194 (38.7%) provided Immediate-TH in 2011 rising to 95 of 192 (49.5%, p=0.003) in 2018 with marked regional variations. In 2011, 394 842 (51.2%) of 771 176 births had no access to Immediate-TH compared with 276 258 (39.3%) of 702 794 births in 2018 (p<0.001). More infants with HIE arrived in the therapeutic temperature range (76.5% vs 67.3%; OR 1.58, 95% CI 1.25 to 2.0, p<0.001) with less overcooling (10.6% vs 14.3%; OR 0.71, 95% CI 0.51 to 0.98, p=0.036) from centres with Immediate-TH compared with those without. Conclusions: Availability of active Immediate-TH has slowly increased although many newborns still have no access and rely on transport team arrival to commence active TH. This is associated with delayed optimal hypothermic management. Provision of Immediate-TH across all units, with appropriate training and support, could improve care of infants with HIE.

Journal Article Type Article
Acceptance Date Mar 17, 2022
Online Publication Date Apr 15, 2022
Publication Date Apr 15, 2022
Deposit Date May 3, 2022
Publicly Available Date May 5, 2022
Journal Archives of Disease in Childhood: Fetal and Neonatal Edition
Electronic ISSN 1468-2052
Publisher BMJ
Peer Reviewed Peer Reviewed
Volume 107
Issue 6
Pages 597-602
DOI https://doi.org/10.1136/archdischild-2021-322906
Keywords Obstetrics and Gynecology; General Medicine; Pediatrics, Perinatology and Child Health
Public URL https://nottingham-repository.worktribe.com/output/7766939
Publisher URL https://fn.bmj.com/content/early/2022/04/14/archdischild-2021-322906

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