Perceptions and Practices of Therapeutic Hypothermia in American Neonatal Intensive Care Units

Abstract

Objective In 2005, therapeutic hypothermia (TH) was used in few American neonatal intensive care units (NICUs) with great variability in practices. We hypothesized that TH would be used with greater frequency and uniformity today.

Study Design We surveyed directors of 797 NICUs queried in our prior study to determine attitudes toward and practices of TH.

Results Of the 781 participants with valid addresses, we received completed surveys from 330 (42.3%). There was an increase in the number of respondents who believed that TH is effective (85% versus 31%, p < 0.0001). More NICUs used TH (50% versus 6%, p < 0.0001) and nearly all not offering TH transferred eligible neonates to centers that did (97% versus 29%, p < 0.0001). There has been increased standardization of TH practices with regard to enrollment criteria, duration, and methods of monitoring.

Conclusion TH has become standard of care for the treatment of HIE in the United States. Most NICUs that use TH adhere to protocols, but variation still exists in TH practices.

Keywords

induced hypothermia - hypoxic-ischemic encephalopathy - neonatal intensive care units

• References

• 1 Perlman JM. Intrapartum hypoxic-ischemic cerebral injury and subsequent cerebral palsy: medicolegal issues. Pediatrics 1997; 99: 851-859
• 2 de Vries LS, Jongmans MJ. Long-term outcome after neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2010; 95: F220-F224
• 3 Marlow N, Rose AS, Rands CE, Draper ES. Neuropsychological and educational problems at school age associated with neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2005; 90: F380-F387
• 4 Vannucci RC, Perlman JM. Interventions for perinatal hypoxic-ischemic encephalopathy. Pediatrics 1997; 100: 1004-1014
• 5 Eicher DJ, Wagner CL, Katikaneni LP , et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32: 11-17
• 6 Gluckman PD, Wyatt JS, Azzopardi D , et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365: 663-670
• 7 Shankaran S, Laptook AR, Ehrenkranz RA , et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353: 1574-1584
• 8 Lang TR, Hartman TKM, Hintz SR, Colby CE. Hypothermia for the treatment of neonatal ischemic encephalopathy: is the genie out of the bottle?. Am J Perinatol 2007; 24: 27-31
• 9 Kapetanakis A, Azzopardi D, Wyatt J, Robertson NJ. Therapeutic hypothermia for neonatal encephalopathy: a UK survey of opinion, practice and neuro-investigation at the end of 2007. Acta Paediatr 2009; 98: 631-635
• 10 Iwata O, Nabetani M, Takenouchi T, Iwaibara T, Iwata S, Tamura M. Working Group on Therapeutic Hypothermia for Neonatal Encephalopathy, Ministry of Health, Labor and Welfare, Japan; Japan Society for Perinatal and Neonatal Medicine. Hypothermia for neonatal encephalopathy: Nationwide Survey of Clinical Practice in Japan as of August 2010. Acta Paediatr 2012; 101: e197-e202
• 11 Jacobs SE, Morley CJ, Inder TE , et al; Infant Cooling Evaluation Collaboration. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165: 692-700
• 12 Azzopardi DV, Strohm B, Edwards AD , et al; TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361: 1349-1358
• 13 Zhou WH, Cheng GQ, Shao XM , et al; China Study Group. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr 2010; 157: 367-372 , e1–e3
• 14 Simbruner G, Mittal RA, Rohlmann F, Muche R. neo.nEURO.network Trial Participants. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126: e771-e778
• 15 Bonifacio SL, Glass HC, Vanderpluym J , et al. Perinatal events and early magnetic resonance imaging in therapeutic hypothermia. J Pediatr 2011; 158: 360-365
• 16 Rutherford M, Ramenghi LA, Edwards AD , et al. Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial. Lancet Neurol 2010; 9: 39-45
• 17 Shankaran S, Barnes PD, Hintz SR , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2012; 97: F398-F404
• 18 Cabana MD, Rand CS, Powe NR , et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282: 1458-1465
• 19 Kahn JM, Rubenfeld GD. Translating evidence into practice in the intensive care unit: the need for a systems-based approach. J Crit Care 2005; 20: 204-206
• 20 Weinert CR, Mann HJ. The science of implementation: changing the practice of critical care. Curr Opin Crit Care 2008; 14: 460-465
• 21 Weinert CR, Gross CR, Marinelli WA. Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospitals. Am J Respir Crit Care Med 2003; 167: 1304-1309
• 22 Young MP, Manning HL, Wilson DL , et al. Ventilation of patients with acute lung injury and acute respiratory distress syndrome: has new evidence changed clinical practice?. Crit Care Med 2004; 32: 1260-1265
• 23 Livingston EH, McNutt RA. The hazards of evidence-based medicine: assessing variations in care. JAMA 2011; 306: 762-763
• 24 Fairchild K, Sokora D, Scott J, Zanelli S. Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU. J Perinatol 2010; 30: 324-329
• 25 Hallberg B, Olson L, Bartocci M, Edqvist I, Blennow M. Passive induction of hypothermia during transport of asphyxiated infants: a risk of excessive cooling. Acta Paediatr 2009; 98: 942-946
• 26 Higgins RD, Raju T, Edwards AD , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Hypothermia Workshop Speakers and Moderators. Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop. J Pediatr 2011; 159: 851-858 , e1
• 27 Shankaran S, Pappas A, McDonald SA , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. Pediatrics 2011; 128 (1) e112-e120
• 28 Thoresen M, HellströmWestas L, Liu X, de Vries LS. Effect of hypothermia on amplitudeintegrated electroencephalogram in infants with asphyxia. Pediatrics 2010; 126 (1) e131-e139
• 29 Stoddard JJ, Cull WL, Jewett EA, Brotherton SE, Mulvey HJ, Alden ER. AAP Committee on Pediatric Workforce Subcommittee on Subspecialty Workforce. Providing pediatric subspecialty care: a workforce analysis. Pediatrics 2000; 106: 1325-1333