Hypothermia therapy for neonatal hypoxic ischemic encephalopathy in the state of California

Abstract

Objective: To characterize the implementation of hypothermia for neonatal hypoxic ischemic encephalopathy (HIE) in a population-based cohort.

Study design: Using the California Perinatal Quality Care Collaborative and California Perinatal Transport System linked 2010-2012 datasets, we categorized infants≥36 weeks' gestation with HIE as receiving hypothermia or normothermia. Sociodemographic and clinical factors were compared, and multivariable logistic regression was used to determine factors associated with hypothermia therapy.

Results: There were 238 reported encephalopathy cases in 2010, 280 in 2011, and 311 in 2012. Hypothermia therapy use in newborns with HIE increased from 59% to 73% across the study period, mainly occurring in newborns with mild or moderate encephalopathy. A total of 36 centers provided hypothermia and cared for 94% of infants, with the remaining 6% being cared for at one of 25 other centers. Of the centers providing hypothermia, 12 centers performed hypothermia therapy to more than 20 patients during the 3-year study period, and 24 centers cared for <20 patients receiving hypothermia. In-hospital mortality was 13%, which primarily was associated with the severity of encephalopathy.

Conclusions: Our findings highlight an opportunity to explore practice-site variation and to develop quality improvement interventions to assure consistent evidence-based care of term infants with HIE and appropriate application of hypothermia therapy for eligible newborns.

Figure. Hospital Variation in Practice

Each individual NICU is represented in the X-axis. Infants with HIE are represented in the Y-axis. Each number on the X-axis corresponds to the same NICU. The total number of patients receiving hypothermia at an individual center ranged from 1 to 68, with 12 centers providing hypothermia therapy to more than 20 patients over the study period. The hypothermia treatment rate for infants with mild HIE varied from 0 to 100%, with a range of 1 to 18 infants. There were 6 centers that treated 100% of their infants with mild HIE (range of 1–7 infants per center). For patients with moderate or severe HIE, 569 (96%) infants were cared for at a cooling center, of which 445 (78%) infants received hypothermia therapy. The hypothermia treatment rate for infants with moderate or severe HIE per center varied from 0 to 100% (rage of 1–56 infants per center), with 16 centers not providing therapy to any of their infants (range of 1 to 4 infants per center).