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  • Quality Improvement Article
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Prevention of excessive hypothermia in infants with hypoxic ischemic encephalopathy prior to admission to a quaternary care center: a neonatal outreach educational project

Journal of Perinatology volume 39, pages 1417–1427 (2019)Cite this article

Subjects

Abstract

Objective

Excessive hypothermia is common in infants that receive passive cooling for hypoxic ischemic encephalopathy (HIE). Our goal was to reduce the number of infants with admission temperature <33 °C from 33% to less than 10% by December 2017.

Methods

Outcome measures included the number of infants with admission temperature <33 °C and number of infants with temperature within therapeutic range. Interventions included implementation of passive cooling guidelines and outreach education to birth hospitals and transport team. We used statistical process control chart to compare outcomes over a 3 year period.

Results

The number of infants with admission temperature <33 °C decreased from 33.3% to 5.5% (p = 0.013). The number of infants with admission temperature within target range for hypothermia therapy increased from 61.1% to 77.7% (p = 0.014). Balancing measures and complications remained unchanged.

Conclusion

Implementation of passive cooling guidelines and outreach education led to significant decrease in excessive hypothermia in infants with HIE.

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References

  1. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet . 2005;365:663–70.

    Article  Google Scholar 

  2. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353:1574–84.

    Article  CAS  Google Scholar 

  3. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361:1349–58.

    Article  CAS  Google Scholar 

  4. Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010;157:367–72. 72 e1-3

    Article  Google Scholar 

  5. Simbruner G, Mittal RA, Rohlmann F, Muche R, neo.n EnTP. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics . 2010;126:e771–8.

    Article  Google Scholar 

  6. Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165:692–700.

    Article  Google Scholar 

  7. Kendall GS, Kapetanakis A, Ratnavel N, Azzopardi D, Robertson NJ, Cooling on Retrieval Study G. Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2010;95:F408–12.

    Article  Google Scholar 

  8. Chaudhary R, Farrer K, Broster S, McRitchie L, Austin T. Active versus passive cooling during neonatal transport. Pediatrics . 2013;132:841–6.

    Article  Google Scholar 

  9. Johnston ED, Becher JC, Mitchell AP, Stenson BJ. Provision of servo-controlled cooling during neonatal transport. Arch Dis Child Fetal Neonatal Ed. 2012;97:F365–7.

    Article  Google Scholar 

  10. O’Reilly KM, Tooley J, Winterbottom S. Therapeutic hypothermia during neonatal transport. Acta Paediatr. 2011;100:1084–6. discussion e49

    Article  Google Scholar 

  11. O’Reilly D, Labrecque M, O’Melia M, Bacic J, Hansen A, Soul JS. Passive cooling during transport of asphyxiated term newborns. J Perinatol. 2013;33:435–40.

    Article  Google Scholar 

  12. Goel N, Mohinuddin SM, Ratnavel N, Kempley S, Sinha A. Comparison of passive and servo-controlled active cooling for infants with hypoxic-ischemic encephalopathy during neonatal transfers. Am J Perinatol. 2017;34:19–25.

    Article  Google Scholar 

  13. Sharma A. Provision of therapeutic hypothermia in neonatal transport: a longitudinal study and review of literature. Cureus . 2015;7:e270.

    PubMed  PubMed Central  Google Scholar 

  14. Fairchild K, Sokora D, Scott J, Zanelli S. Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU. J Perinatol. 2010;30:324–9.

    Article  CAS  Google Scholar 

  15. Hallberg B, Olson L, Bartocci M, Edqvist I, Blennow M. Passive induction of hypothermia during transport of asphyxiated infants: a risk of excessive cooling. Acta Paediatr. 2009;98:942–6.

    Article  Google Scholar 

  16. Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE, et al. Effect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial. J Am Med Assoc. 2014;312:2629–39.

    Article  CAS  Google Scholar 

  17. Natarajan G, Pappas A, Shankaran S, Laptook AR, Walsh M, McDonald SA, et al. Effect of inborn vs. outborn delivery on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy: secondary analyses of the NICHD whole-body cooling trial. Pediatr Res. 2012;72:414–9.

    Article  Google Scholar 

  18. Hein H. Perinatal outreach education--the role of academic medical centers. J Pediatr. 2002;141:151–2.

    Article  Google Scholar 

  19. Allen CW, Jeffery H. Implementation and evaluation of a neonatal educational program in rural Nepal. J Trop Pediatr. 2006;52:218–22.

    Article  Google Scholar 

  20. Byrne BJ, Manhas D. Neonatal outreach simulation. Semin Perinatol. 2016;40:480–8.

    Article  Google Scholar 

  21. Landry MA, Doyle LW, Lee K, Jacobs SE. Axillary temperature measurement during hypothermia treatment for neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2013;98:F54–8.

    Article  Google Scholar 

  22. Anderson ME, Longhofer TA, Phillips W, McRay DE. Passive cooling to initiate hypothermia for transported encephalopathic newborns. J Perinatol. 2007;27:592–3.

    Article  CAS  Google Scholar 

  23. McNellis E, Fisher T, Kilbride HW. Safety and effectiveness of whole body cooling therapy for neonatal encephalopathy on transport. Air Med J. 2015;34:199–206.

    Article  Google Scholar 

  24. Laptook AR, Shankaran S, Tyson JE, Munoz B, Bell EF, Goldberg RN, et al. Effect of therapeutic hypothermia initiated after 6 h of age on death or disability among newborns with hypoxic-ischemic encephalopathy: a randomized clinical trial. J Am Med Assoc. 2017;318:1550–60.

    Article  Google Scholar 

  25. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013;31:CD003311.

    Google Scholar 

  26. Smit E, Liu X, Jary S, Cowan F, Thoresen M. Cooling neonates who do not fulfil the standard cooling criteria—short- and long-term outcomes. Acta Paediatr. 2015;104:138–45.

    Article  Google Scholar 

  27. Austin T, Shanmugalingam S, Clarke P. To cool or not to cool? Hypothermia treatment outside trial criteria. Arch Dis Child Fetal Neonatal Ed. 2013;98:F451–3.

    Article  Google Scholar 

  28. Akula VP, Joe P, Thusu K, Davis AS, Tamaresis JS, Kim S, et al. A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy. J Pediatr. 2015;166:856–61 e1–2.

    Article  Google Scholar 

  29. Weiss MD, Tang A, Young L, Irwin L, Brophy C, Larsen V, et al. Transporting neonates with hypoxic-ischemic encephalopathy utilizing active hypothermia. J Neonatal Perinat Med. 2014;7:173–8.

    CAS  Google Scholar 

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Acknowledgements

We thank the Neonatal transport team at Kentucky Children’s Hospital for their collaboration with implementation of the passive cooling guidelines. Especial thanks to Tina Mc Coy MSN, RN C-NPT, for helping developing the passive cooling guidelines for transport team and collecting the transport logs of all the subjects in this study. We also want to thank Debora Rice BSN, C-NPT for her tremendous investment in providing outreach education to all our referral hospitals. Also we would like to acknowledge Aric Schadler for his important contribution in some of the statistic calculations.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, College of Medicine, University of Kentucky, Lexington, KY, USA

    Susana Arriagada, Kate Fletcher & Peter Giannone

  2. Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY, USA

    Hong Huang

Authors
  1. Susana Arriagada
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  2. Hong Huang
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Contributions

SA: conceptualized and designed the study. She collected data from medical records and transport logs, participated in the interpretation of the data, drafted the first version of the manuscript, reviewed the revisions and approved the final version of the manuscript as submitted. HH: participated in the interpretation of the data, selected the analysis to be used and conducted the statistical analysis. She reviewed the manuscript and approved the final version as submitted. KF: participated in conceptualization and design of the study, she coordinated all the outreach education to referring hospitals, collected and entered data, critically reviewed the manuscript and approved the final version as submitted. PG: critically reviewed the manuscript and the revisions. He approved the final version of the manuscript as submitted.

Corresponding author

Correspondence to Susana Arriagada.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics

This project was identified by the Kentucky Children’s Hospital Institutional Review Board as a quality improvement project and therefore exempt from review.

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Arriagada, S., Huang, H., Fletcher, K. et al. Prevention of excessive hypothermia in infants with hypoxic ischemic encephalopathy prior to admission to a quaternary care center: a neonatal outreach educational project. J Perinatol 39, 1417–1427 (2019). https://doi.org/10.1038/s41372-019-0391-0

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