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Neonatal hypoxic-ischemic encephalopathy diagnosis and treatment: a National Survey in China
Zheng Wang1, Peng Zhang1, Wenhao Zhou1
1Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China.
Insights
Therapeutic hypothermia is not standard for neonatal hypoxic-ischemic encephalopathy (HIE) in China, with varied diagnostic and treatment practices. Standardizing care and increasing hypothermia use can improve outcomes for affected infants.
Area of Science:
- Neonatalogy
- Neurology
- Pediatrics
Background:
- Neonatal hypoxic-ischemic encephalopathy (HIE) affects numerous infants annually in China.
- Therapeutic hypothermia is a proven intervention to reduce HIE-related mortality and long-term neurodevelopmental disabilities.
- National guidelines for HIE management exist but are a decade old.
Purpose of the Study:
- To investigate the current status of HIE diagnosis and treatment practices in China.
- To assess the adoption and adherence to national guidelines for HIE management.
- To identify barriers and opportunities for improving HIE care.
Main Methods:
- A prospective, cross-sectional national survey was conducted.
- Questionnaires evaluated HIE management practices across 273 hospitals in China.
- Descriptive statistics and Chi-square/Fisher's exact tests were used for analysis.
Main Results:
- Significant heterogeneity exists in HIE diagnosis and treatment across Chinese hospitals.
- Therapeutic hypothermia is implemented in only 54% of surveyed hospitals, with lower rates in general hospitals.
- Barriers to hypothermia include perceived reduction in HIE cases, high costs, lack of training, and safety concerns.
Conclusions:
- Therapeutic hypothermia is not yet a standard of care for neonatal HIE nationwide in China.
- Widespread use of unproven neuroprotective agents is noted.
- Standardization of HIE management and broader adoption of therapeutic hypothermia are crucial for improving infant outcomes.
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.
