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Published on: October 28, 2022
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Centre-specific differences in short-term outcomes in neonates with hypoxic-ischaemic encephalopathy
Beate Grass1, Barbara Brotschi1, Cornelia Hagmann1
1Division of Neonatology and Paediatric Intensive Care, University Children's Hospital Zurich, Switzerland.
Swiss Medical Weekly
|May 3, 2021
Summary
Outcomes like seizures, hypotension, infection, and mortality varied significantly among centers treating neonates with hypoxic-ischaemic encephalopathy (HIE) using therapeutic hypothermia. This highlights the need for benchmarking to improve care.
Area of Science:
- Neonatal Medicine
- Pediatric Intensive Care
- Neurology
Background:
- Hypoxic-ischaemic encephalopathy (HIE) is a serious condition in term and near-term neonates.
- Therapeutic hypothermia is a standard treatment for HIE.
- Neonatal/pediatric intensive care units (NICU/PICU) manage these complex cases.
Purpose of the Study:
- To compare center-specific short-term outcomes in neonates with HIE undergoing therapeutic hypothermia.
- To analyze variations in seizures, arterial hypotension, infection, and mortality rates across different treatment centers.
- To establish benchmarks for HIE care and identify areas for improvement.
Main Methods:
- Retrospective analysis of prospectively collected data from the Swiss National Asphyxia and Cooling Register (2011-2018).
- Inclusion of 570 neonates with HIE treated with therapeutic hypothermia in 10 centers.
- Comparison of center-specific outcomes using standardized observed-to-expected values and risk adjustment.
Main Results:
- Significant variations in the incidence of seizures (median 32%), arterial hypotension (median 62%), infection (median 10%), and mortality (median 14%) were observed across centers.
- The range of outcomes demonstrated considerable center-to-center differences.
- Risk adjustment was performed for factors including sex, gestational age, Sarnat score, and delivery complications.
Conclusions:
- Short-term outcomes for neonates with HIE receiving therapeutic hypothermia differ significantly between treatment centers.
- The findings support the need for benchmarking to assess and improve care quality.
- Establishing benchmarks is crucial for enhancing modifiable short-term outcomes in HIE management.
