Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Variations in care of neonates during therapeutic hypothermia: call for care practice bundle implementation

Pediatric Research volume 94, pages 321–330 (2023)Cite this article

Abstract

Background

Therapeutic hypothermia (TH) is the gold-standard treatment for moderate and severe neonatal encephalopathy (NE). Care during TH has implications for long-term outcomes. Outcome variability exists among neonatal intensive care units (NICUs) in Canada, but care variations are not understood well. This study examines variations in care practices for neonates with NE treated with TH in NICUs across Canada.

Methods

A non-anonymous, web-based questionnaire was emailed to tertiary NICUs in Canada providing TH for NE to assess care practices during the first days of life and neurodevelopmental follow-up.

Results

Ninety-two percent (24/26) responded. Centres followed national guidelines regarding the use of the modified Sarnat score to assess the initial severity of NE, the need to initiate TH within the first 6 h of birth, and the importance of follow-up. However, other practices varied, including ventilation mode, definition/treatment of hypotension, routine echocardiography, use of sedation, use of electroencephalogram (EEG), MRI timing, placental analysis, and follow-up duration.

Conclusions

NICUs across Canada follow available national guidelines, but variations exist in practices for managing NE during TH. Development and implementation of a consensus-based care bundle for neonates during TH may reduce practice variability and improve outcomes.

Impact

  • This survey describes the current HIE care practices and variation among tertiary centres in Canada.

  • Variations exist in the care of neonates with NE treated with TH in NICUs across Canada.

  • This paper Identifies areas of variation that are not discussed in detail in the national guidelines and will help to set up quality improvement initiatives.

  • Elucidating the variation in care practices calls for the creation and implementation of a national, consensus-based care bundle, with the objective to improve the outcomes of these critically ill neonates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Therapeutic hypothermia practice agreement chart.

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Liu, L. et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 388, P3027–P3035 (2016).

    Google Scholar 

  2. Bryce, J., Boschi-Pinto, C., Shibuya, K. & Black, R. E. WHO estimates of the causes of death in children. Lancet 365, 1147–1152 (2005).

    PubMed  Google Scholar 

  3. Lawn, J., Shibuya, K. & Stein, C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull. World Health Organ 83, 409–417 (2005).

    PubMed  PubMed Central  Google Scholar 

  4. Perlman, J. M. et al. Cardiovascular Care Science With Treatment Recommendations. Pediatrics 126, e1319–e1344 (2010).

    PubMed  Google Scholar 

  5. Wintermark, P., Mohammad, K. & Bonifacio, S. L. Proposing a care practice bundle for neonatal encephalopathy during therapeutic hypothermia. Semin. Fetal Neonatal Med. 26 (2021). https://doi.org/10.1016/j.siny.2021.101303

  6. Dzakpasu, S. et al. Decreasing diagnoses of birth asphyxia in Canada: fact or artifact. Pediatrics 123, e668–e672 (2009).

    PubMed  Google Scholar 

  7. Jacobs, S. E. et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch. Pediatr. Adolesc. Med 165, 692–700 (2011).

    PubMed  Google Scholar 

  8. Wassink, G. et al. Therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy. Curr. Neurol. Neurosci. Rep. 19, 2-10 (2019).

    PubMed  Google Scholar 

  9. Jacobs, S. E. et al. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst. Rev. 1 (2013). https://doi.org/10.1002/14651858.CD003311.pub3

  10. Jia, W., Lei, X., Dong, W. & Li, Q. Benefits of starting hypothermia treatment within 6 h vs. 6–12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy. BMC Pediatrics 18 (2018). https://doi.org/10.1186/s12887-018-1013-2

  11. Xu, E. H. et al. Neonates with hypoxic-ischemic encephalopathy treated with hypothermia: Observations in a large Canadian population and determinants of death and/or brain injury. J. Neonatal-Perinat. Med. 13, 449–458 (2020).

    CAS  Google Scholar 

  12. Azzopardi, D. et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N. Engl. J. Med. 371, 140–149 (2014).

    CAS  PubMed  Google Scholar 

  13. Shankaran, S. et al. Childhood outcomes after hypothermia for neonatal encephalopathy. N. Engl. J. Med. 366, 2085–2092 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Simbruner, G., Mittal, R. A., Rohlmann, F. & Muche, R. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 126, e771–e778 (2010).

    PubMed  Google Scholar 

  15. Wang, H. et al. Illness severity predicts death and brain injury in asphyxiated newborns treated with hypothermia. Am. J. Perinatol. 35, 951–958 (2018).

    PubMed  Google Scholar 

  16. Lemyre, B. & Chau, V. Hypothermia for newborns with hypoxic-ischemic encephalopathy. Paediatr. Child Health 23, 285–291 (2018).

    PubMed  PubMed Central  Google Scholar 

  17. Sabsabi, B. et al. Asphyxiated neonates treated with hypothermia: birth place matters. Am. J. Perinatol. 39, 298–306 (2022).

    PubMed  Google Scholar 

  18. Mohammad, K. et al. Training in neonatal neurocritical care: a proposal for a hybrid model of competence by design and time-based methods. Pediatr Res. (2021). https://doi.org/10.1038/s41390-021-01727-9

  19. Power, B. D., McGinley, J., Sweetman, D. & Murphy, J. F. A. The modified sarnat score in the assessment of neonatal encephalopathy: a quality improvement initiative. Ir. Med J. 112, 976 (2019).

    CAS  PubMed  Google Scholar 

  20. Variane, G. F. et al. Therapeutic hypothermia in Brazil: a multiprofessional national survey. Am. J. Perinatol. 36, 1150–1156 (2019).

    CAS  PubMed  Google Scholar 

  21. Tsuda, K. et al. Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan. Sci. Rep. 7, 39508 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Wang, Z. et al. Neonatal hypoxic-ischemic encephalopathy diagnosis and treatment: a National Survey in China. BMC Pediatr. 21, 261 (2021).

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Harris, M. N. et al. Perceptions and practices of therapeutic hypothermia in American neonatal intensive care units. Am. J. Perinatol. 31, 15–20 (2014).

    PubMed  Google Scholar 

  24. Wusthoff, C. J. et al. Cooling in neonatal hypoxic-ischemic encephalopathy: practices and opinions on minimum standards in the state of California. J. Perinatol. 38, 54–58 (2018).

    CAS  PubMed  Google Scholar 

  25. Murthy, P. et al. Neuroprotection care bundle implementation to decrease acute brain injury in preterm infants. Pediatr. Neurol. 110, 42–48 (2020).

    PubMed  Google Scholar 

  26. Govindaswami, B. et al. Eliminating risk of intubation in very preterm infants with noninvasive cardiorespiratory support in the delivery room and neonatal intensive care unit. Biomed. Res. Int. 2019, 5984305 (2019).

    PubMed  PubMed Central  Google Scholar 

  27. Frymoyer, A. et al. Sustainability of a clinical examination-based approach for ascertainment of early-onset sepsis in late preterm and term neonates. J. Pediatr. 225, 263–268 (2020).

    PubMed  Google Scholar 

  28. Bierlaire, S., Danhaive, O., Carkeek, K. & Piersigilli, F. How to minimize central line-associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle. Eur. J. Pediatr. 180, 449–460 (2021).

    CAS  PubMed  Google Scholar 

  29. Chiriboga, N. et al. Successful implementation of an intracranial hemorrhage (ICH) bundle in reducing severe ICH: a quality improvement project. J. Perinatol. 39, 143–151 (2019).

    PubMed  Google Scholar 

  30. de Bijl-Marcus, K., Brouwer, A. J., De Vries, L. S., Groenendaal, F. & Wezel-Meijler, G. V. Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study. Arch. Dis. Child Fetal Neonatal Ed. 105, 419–424 (2020).

    PubMed  Google Scholar 

  31. Roychoudhury, S. et al. Implementation of neonatal neurocritical care program improved short-term outcomes in neonates with moderate-to-severe hypoxic ischemic encephalopathy. Pediatr. Neurol. 101, 64–70 (2019).

    PubMed  Google Scholar 

  32. Mohammad, K. et al. Impact of outreach education program on outcomes of neonates with hypoxic ischemic encephalopathy. Paediatr. Child Health 26, e215–e221 (2021).

    PubMed  Google Scholar 

  33. Laptook, A. R. 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. Jama 318, 1550–1560 (2017).

    PubMed  PubMed Central  Google Scholar 

  34. Sabir, H., Bonifacio, S. L., Gunn, A. J., Thoresen, M. & Chalak, L. F. Unanswered questions regarding therapeutic hypothermia for neonates with neonatal encephalopathy. Semin. Fetal Neonatal Med. 26, 101257 (2021).

    PubMed  Google Scholar 

  35. Walløe, L., Hjort, N. L. & Thoresen, M. Major concerns about late hypothermia study. Acta Paediatr. 108, 588–589 (2019).

    PubMed  Google Scholar 

  36. Walløe, L., Hjort, N. L. & Thoresen, M. Why results from Bayesian statistical analyses of clinical trials with a strong prior and small sample sizes may be misleading The case of the NICHD Neonatal Research Network Late Hypothermia Trial. Acta Paediatr. 108, 1190–1191 (2019).

    PubMed  PubMed Central  Google Scholar 

  37. Guillot, M. et al. Influence of timing of initiation of therapeutic hypothermia on brain MRI and neurodevelopment at 18 months in infants with HIE: a retrospective cohort study. BMJ Paediatr. Open 3, e000442 (2019).

    PubMed  PubMed Central  Google Scholar 

  38. Lumba, R., Mally, P., Espiritu, M. & Wachtel, E. V. Therapeutic hypothermia during neonatal transport at Regional Perinatal Centers: active vs. passive cooling. J. Perinat. Med 47, 365–369 (2019).

    PubMed  Google Scholar 

  39. Hagan, J. L. Meta-analysis comparing temperature on arrival at the referral hospital of newborns with hypoxic ischemic encephalopathy cooled with a servo-controlled device versus no device during transport. J. Neonatal Perinat. Med. 14, 29–41 (2021).

    CAS  Google Scholar 

  40. Stafford, T. D., Hagan, J. L., Sitler, C. G., Fernandes, C. J. & Kaiser, J. R. Therapeutic hypothermia during neonatal transport: active cooling helps reach the target. Ther. Hypothermia Temp. Manag 7, 88–94 (2017).

    PubMed  Google Scholar 

  41. Goel, N., Mohinuddin, S. M., 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. 34, 19–25 (2017).

    PubMed  Google Scholar 

  42. Bharadwaj, S. K. & Bhat, B. V. Therapeutic hypothermia using gel packs for term neonates with hypoxic ischaemic encephalopathy in resource-limited settings: a randomized controlled trial. J. Trop. Pediatr. 58, 382–388 (2012).

    PubMed  Google Scholar 

  43. Lopez Laporte, M. A. et al. Association between hypocapnia and ventilation during the first days of life and brain injury in asphyxiated newborns treated with hypothermia. J. Matern Fetal Neonatal Med 32, 1312–1320 (2019).

    PubMed  Google Scholar 

  44. Giannakis, S. et al. Mechanical ventilation, partial pressure of carbon dioxide, increased fraction of inspired oxygen and the increased risk for adverse short-term outcomes in cooled asphyxiated newborns. Children (Basel) 8 (2021). https://doi.org/10.3390/children8060430

  45. Al Balushi, A. et al. Hypotension and brain injury in asphyxiated newborns treated with hypothermia. Am. J. Perinatol. 35, 31–38 (2018).

    PubMed  Google Scholar 

  46. Giesinger, R. E., Bailey, L. J., Deshpande, P. & McNamara, P. J. Hypoxic-ischemic encephalopathy and therapeutic hypothermia: the hemodynamic perspective. J. Pediatr. 180, 22–30.e22 (2017).

    PubMed  Google Scholar 

  47. Lakshminrusimha, S. et al. Pulmonary hypertension associated with hypoxic-ischemic encephalopathy-antecedent characteristics and comorbidities. J. Pediatr. 196, 45–51.e43 (2018).

    PubMed  PubMed Central  Google Scholar 

  48. Lapointe, A. & Barrington, K. J. Pulmonary hypertension and the asphyxiated newborn. J. Pediatr. 158, e19–e24 (2011).

    PubMed  Google Scholar 

  49. Giesinger, R. E. et al. Cardiovascular management following hypoxic–ischemic encephalopathy in North America: need for physiologic consideration. Pediatr. Res. 90, 600–607 (2021).

    PubMed  Google Scholar 

  50. Kovacs, K. et al. A randomized controlled study of low-dose hydrocortisone versus placebo in dopamine-treated hypotensive neonates undergoing hypothermia treatment for hypoxic-ischemic encephalopathy. J. Pediatr. 211, 13–19.e13 (2019).

    CAS  PubMed  Google Scholar 

  51. Mohammad, K. et al. Hemodynamic instability associated with increased risk of death or brain injury in neonates with hypoxic ischemic encephalopathy. J. Neonatal Perinat. Med. 10, 363–370 (2017).

    CAS  Google Scholar 

  52. Al Balushi, A., Guilbault, M. P. & Wintermark, P. in AJP Rep. 6 e48–e58 (2016).

  53. DeLaGarza-Pineda, O. et al. Management of seizures in neonates with neonatal encephalopathy treated with hypothermia. Semin. Fetal Neonatal Med. 26, 101279 (2021).

    PubMed  Google Scholar 

  54. Liow, N. et al. Preemptive morphine during therapeutic hypothermia after neonatal encephalopathy: a secondary analysis. Ther. Hypothermia Temp. Manag. 10, 45–52 (2020).

    PubMed  PubMed Central  Google Scholar 

  55. Sabir, H., Dingley, J., Scull-Brown, E., Chakkarapani, E. & Thoresen, M. Fentanyl induces cerebellar internal granular cell layer apoptosis in healthy newborn pigs. Front. Neurol. 9, 294 (2018).

    PubMed  PubMed Central  Google Scholar 

  56. Vutskits, L. & Xie, Z. Lasting impact of general anaesthesia on the brain: mechanisms and relevance. Nat. Rev. Neurosci. 17, 705–717 (2016).

    CAS  PubMed  Google Scholar 

  57. El-Dib, M., Szakmar, E., Chakkarapani, E. & Aly, H. Challenges in respiratory management during therapeutic hypothermia for neonatal encephalopathy. Semin. Fetal Neonatal Med. 26, 101263 (2021).

    PubMed  Google Scholar 

  58. McIntyre, S. et al. Neonatal encephalopathy: Focus on epidemiology and underexplored aspects of etiology. Semin. Fetal Neonatal Med. 26, 101265 (2021).

    CAS  PubMed  Google Scholar 

  59. Sandoval Karamian, A. G. et al. Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy. Semin. Fetal Neonatal Med. 26, 101272 (2021).

    CAS  PubMed  Google Scholar 

  60. McPherson, C. et al. Management of comfort and sedation in neonates with neonatal encephalopathy treated with therapeutic hypothermia. Semin. Fetal Neonatal Med. 26, 101264 (2021).

    PubMed  PubMed Central  Google Scholar 

  61. Craig, A., Deerwester, K., Fox, L., Jacobs, J. & Evans, S. Maternal holding during therapeutic hypothermia for infants with neonatal encephalopathy is feasible. Acta Paediatr. 108, 1597–1602 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Biskop, E., Paulsdotter, T., Hellström Westas, L., Ågren, J. & Blomqvist, Y. T. Parental participation during therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy. Sex Reprod. Health. 20, 77–80 (2019).

    Google Scholar 

  63. Tasci, B. & Kuzlu Ayyildiz, T. The calming effect of maternal breast milk odor on term infant: a randomized controlled trial. Breastfeed. Med. 15, 724–730 (2020).

    PubMed  Google Scholar 

  64. Pressler, R. M. et al. The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures. Epilepsia 62, 615–628 (2021).

    PubMed  Google Scholar 

  65. Shellhaas, R. A. Continuous electroencephalography monitoring in neonates. Curr. Neurol. Neurosci. Rep. 12, 429–435 (2012).

    PubMed  Google Scholar 

  66. Rennie, J. M. et al. Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience. Arch. Dis. Child Fetal Neonatal Ed. 104, F493–f501 (2019).

    PubMed  Google Scholar 

  67. Thoresen, M., Hellström-Westas, L., Liu, X. & de Vries, L. S. Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia. Pediatrics 126, e131–e139 (2010).

    PubMed  Google Scholar 

  68. Bashir, R. A. et al. Implementation of a neurocritical care program: improved seizure detection and decreased antiseizure medication at discharge in neonates with hypoxic-ischemic encephalopathy. Pediatr. Neurol. 64, 38–43 (2016).

    PubMed  Google Scholar 

  69. Favié, L. M. A. et al. Phenobarbital, midazolam pharmacokinetics, effectiveness, and drug-drug interaction in asphyxiated neonates undergoing therapeutic hypothermia. Neonatology 116, 154–162 (2019).

    PubMed  Google Scholar 

  70. Wisnowski, J. L. et al. Neuroimaging in the term newborn with neonatal encephalopathy. Semin Fetal Neonatal Med 26, 101304 (2021).

    PubMed  PubMed Central  Google Scholar 

  71. Agut, T. et al. Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments: accuracy of MRI performed in the first days of life. BMC Pediatr. 14, 177 (2014).

    PubMed  PubMed Central  Google Scholar 

  72. Boudes, E., Tan, X., Saint-Martin, C., Shevell, M. & Wintermark, P. MRI obtained during versus after hypothermia in asphyxiated newborns. Arch. Dis. Child Fetal Neonatal Ed. 100, F238–F242 (2015).

    PubMed  Google Scholar 

  73. Chakkarapani, E. et al. Reliability of Early Magnetic Resonance Imaging (MRI) and necessity of repeating MRI in noncooled and cooled infants with neonatal encephalopathy. J. Child Neurol. 31, 553–559 (2016).

    PubMed  Google Scholar 

  74. Charon, V. et al. Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up. Eur. J. Radio. 85, 1366–1374 (2016).

    Google Scholar 

  75. Skranes, J. H. et al. Brain imaging in cooled encephalopathic neonates does not differ between four and 11 days after birth. Acta Paediatr. 104, 752–758 (2015).

    PubMed  Google Scholar 

  76. Wintermark, P. et al. Early versus late MRI in asphyxiated newborns treated with hypothermia. Arch. Dis. Child Fetal Neonatal Ed. 96, F36–F44 (2011).

    PubMed  Google Scholar 

  77. Wintermark, P., Labrecque, M., Warfield, S. K., DeHart, S. & Hansen, A. Can induced hypothermia be assured during brain MRI in neonates with hypoxic-ischemic encephalopathy? Pediatr. Radio. 40, 1950–1954 (2010).

    Google Scholar 

  78. Wu, T. W. et al. Maintenance of whole-body therapeutic hypothermia during patient transport and magnetic resonance imaging. Pediatr. Radio. 44, 613–617 (2014).

    Google Scholar 

  79. Penn, A. A. et al. Placental contribution to neonatal encephalopathy. Semin Fetal Neonatal Med 26, 101276 (2021).

    CAS  PubMed  Google Scholar 

  80. Mir, I. N. et al. Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia. Am. J. Obstet. Gynecol. 213, 849.e841–847 (2015).

    Google Scholar 

  81. Wintermark, P., Boyd, T., Gregas, M. C., Labrecque, M. & Hansen, A. Placental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia. Am. J. Obstet. Gynecol. 203, 579.e571–579 (2010).

    Google Scholar 

  82. Vik, T. et al. The Placenta in Neonatal Encephalopathy: A Case–Control Study. J. Pediatr. 202, 77–85 (2018).

    PubMed  Google Scholar 

  83. Schreglmann, M., Ground, A., Vollmer, B. & Johnson, M. J. Systematic review: long-term cognitive and behavioural outcomes of neonatal hypoxic-ischaemic encephalopathy in children without cerebral palsy. Acta Paediatr. 109, 20–30 (2020).

    PubMed  Google Scholar 

  84. Novak, I. et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 171, 897–907 (2017).

    PubMed  PubMed Central  Google Scholar 

  85. Cramer, S. C. et al. Harnessing neuroplasticity for clinical applications. Brain 134, 1591–1609 (2011).

    PubMed  PubMed Central  Google Scholar 

  86. Marlow, N., Shankaran, S., Rogers, E. E., Maitre, N. L. & Smyser, C. D. Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia. Semin. Fetal Neonatal Med. 26, 101274 (2021).

    PubMed  Google Scholar 

  87. Cascio, A. et al. Discussing brain magnetic resonance imaging results for neonates with hypoxic-ischemic encephalopathy treated with hypothermia: A challenge for clinicians and parents. eNeurologicalSci 29, 100424 (2022).

    PubMed  PubMed Central  Google Scholar 

  88. Pilon, B., Craig, A. K., Lemmon, M. E. & Goeller, A. Supporting families in their child’s journey with neonatal encephalopathy and therapeutic hypothermia. Semin. Fetal Neonatal Med. 26, 101278 (2021).

    PubMed  PubMed Central  Google Scholar 

  89. Goswami, I. R. et al. Characteristics and short-term outcomes of neonates with mild hypoxic-ischemic encephalopathy treated with hypothermia. J. Perinatol. 40, 275–283 (2020).

    PubMed  Google Scholar 

  90. Pouppirt, N. R. et al. The general movements assessment in neonates with hypoxic ischemic encephalopathy. J. Child Neurol. 36, 601–609 (2021).

    PubMed  Google Scholar 

  91. Procianoy, R. S., Corso, A. L., Longo, M. G., Vedolin, L. & Silveira, R. C. Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: magnetic resonance imaging findings and neurological outcomes in a Brazilian cohort. J. Matern Fetal Neonatal Med. 32, 2727–2734 (2019).

    PubMed  Google Scholar 

  92. Apaydın, U. et al. The use of neuroimaging, Prechtl’s general movement assessment and the Hammersmith infant neurological examination in determining the prognosis in 2-year-old infants with hypoxic ischemic encephalopathy who were treated with hypothermia. Early Hum. Dev. 163, 105487 (2021).

    PubMed  Google Scholar 

  93. Haataja, L. et al. Optimality score for the neurologic examination of the infant at 12 and 18 months of age. J. Pediatr. 135, 153–161 (1999).

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the additional clinicians, who answered the survey: Dr. Georges Caouette, Dr. Michael Castaldo, Dr. Sibasis Daspal, Dr. Salhab El Helou, Dr. Alyssa Morin, Dr. Darlene Toope, and Dr. Jennifer Toye. We also thank Mr. Wayne Ross Egers for his professional English editing of our study.

Funding

P.W. is supported by FRSQ Clinical Research Scholar Career Award Senior and a Canadian Institutes of Health Research (CIHR) Project Grant.

Author information

Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Khorshid Mohammad

  2. University of Calgary, Calgary, AB, Canada

    Samantha McIntosh & Kyong-Soon Lee

  3. Hospital for Sick Children, Division of Neonatology, Department of Paediatrics, Toronto, ON, Canada

    Kyong-Soon Lee & Diane Wilson

  4. Division of Neonatology, Montreal Children’s Hospital, Montreal, QC, Canada

    Marc Beltempo & Pia Wintermark

  5. McGill University Health Centre—Research Institute, Montreal, QC, Canada

    Marc Beltempo & Pia Wintermark

  6. Division of Neonatal Perinatal Medicine, IWK Health Centre, Dalhousie University, Halifax, NS, Canada

    Jehier Afifi

  7. Hôpital Sainte-Justine, Montreal, QC, Canada

    Sophie Tremblay

  8. University of Montreal, Montreal, QC, Canada

    Sophie Tremblay

  9. University of Toronto, Toronto, ON, Canada

    Prakesh Shah & Eugene Ng

  10. Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh Shah

  11. Department of Pediatrics, Regina General Hospital, Regina, SK, Canada

    Jaya Bodani

  12. College of Medicine, University of Saskatchewan, Saskatchewan, SK, Canada

    Jaya Bodani

  13. Kingston General Hospital, Kingston, ON, Canada

    Faiza Khurshid

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

    Hala Makary

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

    Eugene Ng

  16. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Ipsita Goswami

  17. Department of Pediatrics, CHU de Québec-Université Laval, Quebec, Quebec, QC, Canada

    Mireille Guillot

  18. Department of Pediatrics, Division of Neonatal-Perinatal Care, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada

    Mathew Hicks

  19. Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada

    Elka Miller

  20. Hope for HIE, PO Box 250472, West Bloomfield, MI, USA

    Betsy Pilon

  21. Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada

    Stephanie Redpath

  22. Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

    James Scott

  23. BC Women’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Sandesh Shivananda

  24. Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Ganesh Srinivasan

  25. Neonatal Intensive Care Unit, Royal Columbian Hospital, New Westminster, BC, V3L 3W7, Canada

    Miroslav Stavel

  26. Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada

    Stephen Wood

  27. Department of Pediatrics, Moncton Hospital, Moncton, AB, Canada

    Roderick Canning

  28. Division of Newborn Medicine, Department of Pediatrics, Memorial University of Newfoundland and Labrador, St. John’s, NL, Canada

    Akhil Deshpandey

  29. Department of Pediatrics, Victoria General Hospital, Victoria, BC, Canada

    Jaideep Kanungo

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

    Luis Monterrosa

  31. Department of Pediatrics, Hôpital Fleurimont, Sherbrooke, Québec, QC, Canada

    Alyssa Morin

  32. Department of Pediatrics, London Health Sciences Centre, London, ON, Canada

    Henry Roukema

  33. Department of Pediatrics, Surrey Memorial Hospital, Surrey, BC, Canada

    Rebecca Sherlock

Authors
  1. Khorshid Mohammad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samantha McIntosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyong-Soon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Beltempo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jehier Afifi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sophie Tremblay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Prakesh Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Diane Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jaya Bodani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Faiza Khurshid
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hala Makary
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Eugene Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Pia Wintermark
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the NeoBrainNetwork

  • Ipsita Goswami
  • , Mireille Guillot
  • , Mathew Hicks
  • , Elka Miller
  • , Betsy Pilon
  • , Stephanie Redpath
  • , James Scott
  • , Sandesh Shivananda
  • , Ganesh Srinivasan
  • , Miroslav Stavel
  • , Stephen Wood
  • , Roderick Canning
  • , Akhil Deshpandey
  • , Jaideep Kanungo
  • , Luis Monterrosa
  • , Alyssa Morin
  • , Henry Roukema
  •  & Rebecca Sherlock

Contributions

M.K., M.S., and W.P.: Analysis and interpretation of data, wrote, and edited the manuscript. W.P.: Designed and conducted the survey. All other authors: Answered the survey and critically revised the manuscript, approved the manuscript to be published.

Corresponding author

Correspondence to Khorshid Mohammad.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohammad, K., McIntosh, S., Lee, KS. et al. Variations in care of neonates during therapeutic hypothermia: call for care practice bundle implementation. Pediatr Res 94, 321–330 (2023). https://doi.org/10.1038/s41390-022-02453-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-022-02453-6

Search

Advanced search

Quick links