Respiratory management in neonates with hypoxic-ischemic encephalopathy during therapeutic hypothermia: a binational...

The respiratory management of neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) is a challenging issue, but remains poorly standardized. The aim of this study was to describe current practice regarding respiratory management, particularly tracheal intubation, in neonates undergoing TH in France and French-speaking Belgium. In this binational cross-sectional study, current practices about respiratory management were collected by an online-based survey sent to all tertiary neonatal intensive care units providing TH in France and French-speaking Belgium. Practices were analyzed to assess their heterogeneity and compared between centers that routinely intubate for TH and those that did not. The survey was completed by 57/68 (84%) centers. Routine intubation during TH was reported by 33 (58%) centers. Motivations behind routine intubation during TH included concerns about pain, discomfort, and neuroprotection. Among the 24 other centers, there was significant heterogeneity in the respiratory care of patients, while practices regarding sedation-analgesia appeared more consensual. The country was the only characteristic independently associated with routine intubation during TH (France vs Belgium: OR = 9.333, 95% CI 1.035-84.202, p = 0.047).

Respiratory management of neonates with HIE undergoing TH is highly heterogeneous. Most centers routinely intubate neonates undergoing TH, especially in France. These findings highlight the need for more evidence-based studies and guidelines to optimize respiratory care during TH.

• For neonates with hypoxic-ischemic encephalopathy, evidence to guide respiratory management during therapeutic hypothermia remains scarce. • Yet, ventilation is a crucial aspect of the neuroprotective management of these neonates.

• This binational survey reveals that most centers routinely intubate neonates undergoing therapeutic hypothermia. • Our findings also suggest significant heterogeneity and may help to design future studies.