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. 2021 Jun 5;21(1):261.
doi: 10.1186/s12887-021-02737-6.

Neonatal hypoxic-ischemic encephalopathy diagnosis and treatment: a National Survey in China

Zheng Wang  1 , Peng Zhang  1 , Wenhao Zhou  1 , Shiwen Xia  2 , Wei Zhou  3 , Xiaoyu Zhou  4 , Xiuyong Cheng  5 , Yuan Shi  6 , Zhenlang Lin  7 , Dongli Song  8   9 , Guoqiang Cheng  10
Affiliations

Neonatal hypoxic-ischemic encephalopathy diagnosis and treatment: a National Survey in China

Zheng Wang et al. BMC Pediatr. .

Abstract

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) affects as many as 100,000 infants each year in China. Therapeutic hypothermia reduces HIE related mortality and long-term neurodevelopmental disabilities. National guidelines for HIE management were published a decade ago. This study aimed to investigate the current status of HIE diagnosis and treatment in China.

Method: This prospective cross-sectional national survey used a questionnaire evaluating practices related to HIE management. Descriptive statistics and Chi-square or Fisher's exact test were used, and a p-value of < 0.05 was considered significant.

Results: The 273 hospitals that completed the survey were located in 31 of the 34 provincial districts in China. Eighty-eight percent of the hospitals were Level III hospitals, and 74% treated 10 or more HIE cases annually. Awareness rates of the national guidelines for HIE diagnosis, HIE treatment, and therapeutic hypothermia protocol were 85, 63, and 78%, respectively. Neurological manifestations and blood gas were used as HIE diagnostic criteria by 96% (263/273) and 68% (186/273) of the hospitals, respectively. Therapeutic hypothermia was used in 54% (147/273) of hospitals. The percentage of general hospitals that implemented therapeutic hypothermia (43%, 71/165) was significantly lower than that in maternity and infant hospitals (67%, 49/73) (χ2 = 11.752, p = 0.001) and children's hospitals (77%, 27/35) (χ2 = 13.446, p < 0.001). Reasons for not providing therapeutic hypothermia included reduction of HIE cases in recent years (39%), high cost of cooling devices and treatment (31%), lack of training (26%), and safety concerns (4%). Among the hospitals that provided therapeutic hypothermia, 27% (39/147) were in full compliance with the recommended protocol. Eighty-one percent (222/273) of the hospitals treated HIE infants with putative neuroprotective agents alone or in combination with cooling. Ninety-one percent of the hospitals had long-term neurodevelopmental follow-up programs for infants with HIE.

Conclusions: There is significant heterogeneity in HIE diagnosis and treatment in China. Therapeutic hypothermia has not become a standard of care for neonatal HIE nationwide. Unproven agents are widely used for HIE treatment. Nationwide standardization of HIE management and dissemination of therapeutic hypothermia represent the opportunities to reduce mortality and improve long-term neurodevelopmental outcomes of children affected by HIE.

Keywords: Long term follow-up; Neonatal hypoxic-ischemic encephalopathy; Neuroprotective agent; Therapeutic hypothermia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Geographic distribution of survey respondents. A grayscale map of China was divided into five levels depends on population density. The fractions represented the number of hospitals that participated in the survey (denominator) and the number of surveyed hospitals that performed hypothermia treatment (numerator) in each province. The map depicted in Fig. 1 is my own and it was not taken from another source
See this image and copyright information in PMC

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