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. 2021 Dec;41(12):2804-2812.
doi: 10.1038/s41372-021-01156-w. Epub 2021 Jul 21.

Process variations between Swiss units treating neonates with hypoxic-ischemic encephalopathy and their effect on short-term outcome

Mark Adams  1 , Barbara Brotschi  2 , André Birkenmaier  3 , Katharina Schwendener  4 , Verena Rathke  2 , Michael Kleber  5 , Cornelia Hagmann  2 ; Swiss National Asphyxia and Cooling Register Group
Collaborators, Affiliations

Process variations between Swiss units treating neonates with hypoxic-ischemic encephalopathy and their effect on short-term outcome

Mark Adams et al. J Perinatol. 2021 Dec.

Abstract

Objective: To compare therapeutic hypothermia (TH) treatment of term and near-term neonates with hypoxic-ischemic encephalopathy (HIE) between neonatal units.

Study design: Population-based, retrospective analysis of TH initiation and maintenance, and of diagnostic imaging. The comparison between units was based on crude data analysis, indirect standardization, and adjusted logistic regression.

Results: TH was provided to 570 neonates with HIE between 2011 and 2018 in 10 Swiss units. We excluded 121 off-protocol cooled neonates to avoid selection bias. Of the remaining 449 neonates, the outcome was favorable to international benchmarks, but there were large unit-to-unit variations in baseline perinatal data and TH management. A total of 5% neonates did not reach target temperature within 7 h (3-10% between units), and 29% experienced over- or undercooling (0-38%).

Conclusion: Although the neonates had favorable short-term outcomes, areas for improvement remain for Swiss units in both process and outcome measures.

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Conflict of interest statement

MA receives a salary as network coordinator for SwissNeoNet, the host of the National Asphyxia and Cooling Register. The remaining authors have no potential conflicts of interest relevant to this article to disclose.

Figures

Fig. 1
Fig. 1. Study flow chart.
*Estimated total number of neonates with moderate to severe HIE in Switzerland 2011-2018: 449 + 45 (missing unit of average unit size) + 46 (off-protocol cooled neonates with moderate-to-severe HIE) = 540, i.e., ca. 68 per year. † major malformations: 2 trisomy 21, 1 congenital diaphragmatic hernia, 1 transposition of the large vessels, 1 esophageal atresia, 1 hydrops fetalis, 1 Turner syndrome, 1 microcephalia. HIE: hypoxic ischemic encephalopathy; TH: therapeutic hypothermia.
Fig. 2
Fig. 2. Unit specific standardized mortality/morbidity ratio overview with 95% confidence intervals of process deviations.
Standardized, risk-adjusted processes as observed over expected ratios with the entire cohort as reference (=1). *analysis of survivors only.
Fig. 3
Fig. 3. Adjusted odds ratios with 95% confidence intervals to reveal possible associations between process deviations and short-term outcome.
Symbol (*) shows analysis of survivors only. Target temp. not reached in 7 h: none of the infants cooled >7 h died.
See this image and copyright information in PMC

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