Increase in Standardized Management of Neonates with Hypoxic-Ischemic Encephalopathy Since Implementation of a Patient Register

Increase in Standardized Management of Neonates with Hypoxic-Ischemic Encephalopathy Since Implementation of a Patient Register

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. Thi...

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Veröffentlicht in:Therapeutic hypothermia and temperature management 2023-12, Vol.13 (4), p.175-183
Hauptverfasser: Birkenmaier, André, Adams, Mark, Kleber, Michael, Schwendener Scholl, Katharina, Rathke, Verena, Hagmann, Cornelia, Brotschi, Barbara, Grass, Beate
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container_end_page 183
container_issue 4
container_start_page 175
container_title Therapeutic hypothermia and temperature management
container_volume 13
creator Birkenmaier, André
Adams, Mark
Kleber, Michael
Schwendener Scholl, Katharina
Rathke, Verena
Hagmann, Cornelia
Brotschi, Barbara
Grass, Beate
description 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  
doi_str_mv 10.1089/ther.2022.0055
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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  &lt; 0.001). In 2015–2018, adherence to performing a cranial magnetic resonance imaging after rewarming improved ( p  &lt; 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. 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In 2015–2018, adherence to performing a cranial magnetic resonance imaging after rewarming improved ( p  &lt; 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. 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title Increase in Standardized Management of Neonates with Hypoxic-Ischemic Encephalopathy Since Implementation of a Patient Register
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