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Therapeutic Hypothermia in Mild Neonatal Encephalopathy: a National Survey

Presented at the Neonatal Society 2017 Summer Meeting (programme).

Oliveira V1, Singhvi DP1, Montaldo P1, Lally PJ1, Mendoza J1, Manerkar S2, Shankaran S3, Thayyil S1

1 Centre for Perinatal Neuroscience, Imperial College London, UK
2 Neonatal Unit, Lokmanya Tilak Municipal General Hospital, Mumbai, India
3 Neonatal-Perinatal Medicine, Wayne State University, USA

Background: Although National Institute of Clinical Excellence recommend cooling treatment only for term infants who suffer moderate or severe hypoxic ischemic encephalopathy (HIE) (1), anecdotal evidence suggests cooling therapy is increasingly offered in mild HIE (2). Here we report a national survey on cooling practices for babies with mild HIE in the UK.

Methods: We requested the lead consultant of all cooling centres in the UK to complete an electronic survey (Qualtrics® (Qualtrics LLC, Provo, Utah, U.S.A.) relating to cooling practices in their unit for babies with mild HIE. Responses were then screened for duplications and data completeness assessed before analysis, using Microsoft Excel.

Results: We contacted 74 centres; only 68 were still offering cooling treatment. We received 54 responses (79%) of which we included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33-34oC core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hrs. Babies were ventilated for cooling only in two (6%) units and only 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in 8 (22%) units. Magnetic resonance imaging and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively.

Conclusion: Most cooling centres in the U.K. offer therapeutic hypothermia to babies with mild neonatal encephalopathy and variations from established cooling protocols (for moderate and severe encephalopathy) are common. Further observational and interventional research is required to optimise neuroprotection in babies with mild HIE.

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1. National Institute for Health and Care Excellence (NICE, 2010)
2. Mehta et al 2017 in Journal of Pediatrics and Child Health, 53 (3)

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