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

Journal of Perinatology volume 42, pages 898–906 (2022)Cite this article

Subjects

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.

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Fig. 1
Fig. 2: Rates of mortality, brain injury and mortality/brain injury stratified by NICU and by severity of HIE.
Fig. 3: NICU Standardized ratios of mortality, brain injury and mortality/brain injury.

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Acknowledgements

The authors gratefully acknowledge all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON for organizational support of CNN.

Funding

MB holds an Early Career Investigator Grant from the CIHR Institute of Human Development, Child and Youth Health (IHDCYH), a Research Grant Funding from the FRSQ Clinical Research Scholar Career Award Junior 1, and an Early Career Investigator Grant from the Montreal Children’s Hospital Foundation. This study was supported by a grant from the Canadian Institutes of Health Research (CIHR) funding the Canadian Preterm Birth Network (PBN 150642). PW receives research grant funding from the FRSQ Clinical Research Scholar Career Award Junior 2 and a CIHR Project Grant.

Author information

Authors and Affiliations

  1. Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada

    Marc Beltempo, Pia Wintermark & Elias Jabbour

  2. Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Khorshid Mohammad & Carlos Fajardo

  3. Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS, Canada

    Jehier Afifi

  4. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Sandesh Shivananda

  5. Division of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada

    Deepak Louis

  6. Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Stephanie Redpath

  7. Division of Neonatology, Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Kyong-Soon Lee

  8. Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah & Shoo K. Lee

  9. Victoria General Hospital, Victoria, BC, Canada

    Jaideep Kanungo

  10. British Columbia Women’s Hospital, Vancouver, BC, Canada

    Joseph Ting

  11. Royal Columbian Hospital, New Westminster, BC, Canada

    Zenon Cieslak

  12. Surrey Memorial Hospital, Surrey, BC, Canada

    Rebecca Sherlock

  13. Foothills Medical Centre, Calgary, AB, Canada

    Ayman Abou Mehrem

  14. Royal Alexandra Hospital, Edmonton, AB, Canada

    Jennifer Toye & Khalid Aziz

  15. Regina General Hospital, Regina, SK, Canada

    Jaya Bodani

  16. Royal University Hospital, Saskatoon, SK, Canada

    Lannae Strueby

  17. Winnipeg Health Sciences Centre, Winnipeg, MB, Canada

    Mary Seshia

  18. St. Boniface General Hospital, Winnipeg, MB, Canada

    Ruben Alvaro

  19. Hamilton Health Sciences Centre, Hamilton, ON, Canada

    Amit Mukerji

  20. London Health Sciences Centre, London, ON, Canada

    Orlando Da Silva

  21. Windsor Regional Hospital, Windsor, ON, Canada

    Sajit Augustine

  22. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Eugene Ng

  23. The Ottawa Hospital, Ottawa, ON, Canada

    Brigitte Lemyre

  24. Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Thierry Daboval

  25. Kingston General Hospital, Kingston, ON, Canada

    Faiza Khurshid

  26. Jewish General Hospital, Montréal, ON, Canada

    Victoria Bizgu

  27. Hôpital Sainte-Justine, Montréal, ON, Canada

    Keith Barrington, Anie Lapointe & Guillaume Ethier

  28. Centre Hospitalier Universitaire de Québec, Sainte Foy, QC, Canada

    Christine Drolet & Bruno Piedboeuf

  29. Montreal Children’s Hospital at McGill University Health Centre, Montréal, QC, Canada

    Martine Claveau

  30. Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada

    Marie St-Hilaire

  31. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Valerie Bertelle & Edith Masse

  32. Moncton Hospital, Moncton, NB, Canada

    Roderick Canning

  33. Dr. Everett Chalmers Hospital, Fredericton, NB, Canada

    Hala Makary

  34. Saint John Regional Hospital, Saint John, NB, Canada

    Cecil Ojah & Luis Monterrosa

  35. Janeway Children’s Health and Rehabilitation Centre, St. John’s, NL, Canada

    Julie Emberley

  36. Cape Breton Regional Hospital, Sydney, NS, Australia

    Andrzej Kajetanowicz

Authors
  1. Marc Beltempo
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  2. Pia Wintermark
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  3. Khorshid Mohammad
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  4. Elias Jabbour
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  5. Jehier Afifi
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  6. Sandesh Shivananda
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  7. Deepak Louis
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  8. Stephanie Redpath
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  9. Kyong-Soon Lee
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Consortia

Canadian Neonatal Network Investigators

  • Shoo K. Lee
  • , Jaideep Kanungo
  • , Joseph Ting
  • , Zenon Cieslak
  • , Rebecca Sherlock
  • , Ayman Abou Mehrem
  • , Jennifer Toye
  • , Khalid Aziz
  • , Jaya Bodani
  • , Lannae Strueby
  • , Mary Seshia
  • , Ruben Alvaro
  • , Amit Mukerji
  • , Orlando Da Silva
  • , Sajit Augustine
  • , Eugene Ng
  • , Brigitte Lemyre
  • , Thierry Daboval
  • , Faiza Khurshid
  • , Victoria Bizgu
  • , Keith Barrington
  • , Anie Lapointe
  • , Guillaume Ethier
  • , Christine Drolet
  • , Bruno Piedboeuf
  • , Martine Claveau
  • , Marie St-Hilaire
  • , Valerie Bertelle
  • , Edith Masse
  • , Roderick Canning
  • , Hala Makary
  • , Cecil Ojah
  • , Luis Monterrosa
  • , Julie Emberley
  •  & Andrzej Kajetanowicz

Contributions

MB conceptualized and designed the study, collected the data, analyzed the data, drafted the manuscript, and adjusted the manuscript according to the comments of co-authors. PW, KM, EJ, JA, SS, DL, SR, KSL, CF, and PS provided review and critical appraisal of the manuscript.

Corresponding author

Correspondence to Marc Beltempo.

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The authors declare no competing interests.

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Beltempo, M., Wintermark, P., Mohammad, K. et al. Variations in practices and outcomes of neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia across tertiary NICUs in Canada. J Perinatol 42, 898–906 (2022). https://doi.org/10.1038/s41372-022-01412-7

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