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

Marc Beltempo; Pia Wintermark; Khorshid Mohammad; Elias Jabbour; Jehier Afifi; Sandesh Shivananda; Deepak Louis; Stephanie Redpath; Kyong-Soon Lee; Carlos Fajardo; Prakesh S Shah; Canadian Neonatal Network Investigators

doi:10.1038/s41372-022-01412-7

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

J Perinatol. 2022 Jul;42(7):898-906. doi: 10.1038/s41372-022-01412-7. Epub 2022 May 12.

Collaborators

Affiliations

¹ Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada. marc.beltempo@mcgill.ca.
² Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada.
³ Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
⁴ Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.
⁵ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
⁶ Division of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
⁷ Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
⁸ Division of Neonatology, Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
⁹ Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.

PMID: 35552529
DOI: 10.1038/s41372-022-01412-7

Abstract

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Injuries* / therapy
Canada
Humans
Hypothermia, Induced*
Hypoxia-Ischemia, Brain* / diagnostic imaging
Hypoxia-Ischemia, Brain* / therapy
Infant, Newborn
Intensive Care Units, Neonatal
Retrospective Studies

Grants and funding

87518/Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada)