Variations in practices and outcomes of neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia across tertiary NICUs in Canada

• Published in: Journal of perinatology Vol. 42; no. 7; pp. 898 - 906
• Main Authors: Beltempo, Marc, Wintermark, Pia, Mohammad, Khorshid, Jabbour, Elias, Afifi, Jehier, Shivananda, Sandesh, Louis, Deepak, Redpath, Stephanie, Lee, Kyong-Soon, Fajardo, Carlos, Shah, Prakesh S.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-07-2022; Nature Publishing Group
• Subjects: 692/308/174; 692/700/1720; Birth weight; Blood products; Brain; Brain damage; Brain injury; Data collection; Encephalopathy; Gestational age; Head injuries; Hospitals; Hypothermia; Hypoxia; Intensive care; Intensive care units; Ischemia; Magnetic resonance imaging; Medicine; Medicine & Public Health; Mortality; Neonatal care; Neonates; Newborn babies; Nitric oxide; Pediatric Surgery; Pediatrics; Premature babies; Quality improvement; Quality standards; Traumatic brain injury; Variation; Ventilators; Canada
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-022-01412-7

Objective
To characterize variations in practices and outcomes for neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) across Canadian tertiary Neonatal Intensive Care Units (NICUs).
Study design
Retrospective study of neonates admitted for HIE and treated with TH in 24 tertiary NICUs from the Canadian Neonatal Network, 2010–2020. The two primary outcomes of mortality before discharge and MRI-detected brain injury were compared across NICUs using adjusted standardized ratios (SR) with 95% CI.
Results
Of the 3261 neonates that received TH, 367 (11%) died and 1033 (37%) of the 2822 with MRI results had brain injury. Overall, rates varied significantly across NICUs for mortality (range 5–17%) and brain injury (range 28–51%). Significant variations in use of inotropes, inhaled nitric oxide, blood products, and feeding during TH were identified (
p
values < 0.01).
Conclusion
Significant variations exist in practices and outcomes of HIE neonates treated with hypothermia across Canada.