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Blanket temperature during therapeutic hypothermia and outcomes in hypoxic ischemic encephalopathy

Journal of Perinatology volume 42, pages 348–353 (2022)Cite this article

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Abstract

Objective

Determine whether blanket temperatures during therapeutic hypothermia (TH) are associated with 18–22 month outcomes for infants with hypoxic ischemic encephalopathy (HIE).

Study design

Retrospective cohort study of 181 infants with HIE who received TH in two randomized trials within the Neonatal Research Network. We defined summative blanket temperature constructs and evaluated for association with a primary composite outcome of death or moderate/ severe disability at 18–22 months.

Results

Each 0.5 °C above 33.5 °C in the mean of the highest quartile blanket temperature was associated with a 52% increase in the adjusted odds of death/ disability (aOR 1.52, 95% CI 1.09–2.11). Having >8 consecutive blanket temperatures above 33.5 °C rendered an aOR of death/disability of 5.04 in the first 24 h (95% CI 1.54–16.6) and 6.92 in the first 48 h (95% CI 2.20–21.8) of TH.

Conclusions

Higher blanket temperature during TH may be an early, clinically useful biomarker of HIE outcome.

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Fig. 1: Cohort assembly.
Fig. 2: Percent of infants with death or disability stratified by consecutive blanket temperatures > 33.5 °C.

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Acknowledgements

This work was supported and funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Neonatal Research Network (NRN). Participating NRN sites collected data and transmitted it to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, RTI International had full access to all of the data in the study, and with the NRN Center Principal Investigators, takes responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in the original trials informing this study.

Author information

Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    John Flibotte, Sara B. DeMauro, Eric C. Eichenwald & Erik A. Jensen

  2. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    John Flibotte, Sara B. DeMauro, Eric C. Eichenwald & Erik A. Jensen

  3. Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA

    Abbot R. Laptook

  4. Department of Pediatrics, Wayne State University, Detroit, MI, USA

    Seetha Shankaran

  5. Biostatistics and Epidemiology, RTI International, Research Triangle Park, NC, USA

    Scott A. McDonald

  6. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Mariana C. Baserga & Tara L. DuPont

  7. Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Edward F. Bell

  8. Department of Pediatrics, Duke University, Durham, NC, USA

    C. Michael Cotten

  9. Biostatistics and Epidemiology, RTI International, Rockville, MD, USA

    Abhik Das

  10. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Roy Heyne

  11. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Krisa P. Van Meurs & Krisa P. Van Meurs

  12. Division of Neonatal and Perinatal Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Kevin Dysart

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  1. John Flibotte
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Consortia

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

  • John Flibotte
  • , Abbot R. Laptook
  • , Seetha Shankaran
  • , Scott A. McDonald
  • , Mariana C. Baserga
  • , Edward F. Bell
  • , C. Michael Cotten
  • , Abhik Das
  • , Sara B. DeMauro
  • , Tara L. DuPont
  • , Eric C. Eichenwald
  • , Roy Heyne
  • , Erik A. Jensen
  • , Krisa P. Van Meurs
  •  & Kevin Dysart

Contributions

JF and KD conceived of this study and proposed initial design. ARL, SS, MCB, EFB, CMC, SBD, TLD, ECE, RH, EAJ, KPV critically reviewed the design and offered revisions. SAM and AD designed approach to and performed statistical analysis. JF drafted the manuscript and all authors critically reviewed and approved the final content.

Corresponding author

Correspondence to Kevin Dysart.

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Competing interests

For the Induced Hypothermia trial: Dr. Cotten reports having served on the data and safety monitoring board for the Inhibitex phase 3 study of Vernonate for the prevention of infections in preterm infants.

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Flibotte, J., Laptook, A.R., Shankaran, S. et al. Blanket temperature during therapeutic hypothermia and outcomes in hypoxic ischemic encephalopathy. J Perinatol 42, 348–353 (2022). https://doi.org/10.1038/s41372-021-01302-4

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  • DOI: https://doi.org/10.1038/s41372-021-01302-4

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