Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Reducing Variability in Practice through a...

Area of Science:

• Neonatal medicine
• Neurocritical care
• Medical education

Background:

• Neurocritical care for newborns with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH) exhibits significant practice variation, particularly in low- and middle-income countries.
• This heterogeneity can compromise the efficacy of neuroprotective strategies, leading to suboptimal outcomes for affected infants.

Purpose of the Study:

• To evaluate the feasibility of a tele-educational training program aimed at standardizing neurocritical care for HIE newborns undergoing TH.
• To assess the program's impact on reducing practice variations in TH protocols across multiple neonatal intensive care units.

Main Methods:

• A prospective study involving 12 Brazilian neonatal intensive care units from February 2021 to February 2022.
• Implementation of a 6-month tele-educational intervention comprising biweekly live videoconferences, with half the centers receiving remote neuromonitoring support.
• Evaluation of protocol deviations, focusing on TH compliance and Sarnat examinations, before and after the intervention using logistic regression.

Main Results:

• While overall TH protocol deviations did not significantly decrease, a significant reduction in missed Sarnat examinations within 6 hours of birth was observed post-intervention (aOR: 0.36).
• Centers with remote neuromonitoring support demonstrated significantly lower rates of seizures (27.6% vs. 57.5%) and reduced use of seizure medication (27.6% vs. 68.7%).

Conclusions:

• Tele-educational programs are a feasible approach to enhance neonatal neurocritical care delivery for HIE infants treated with TH.
• International collaboration and tele-education can effectively decrease care variability, potentially improving neuroprotection and outcomes for HIE newborns.