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Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis
  1. Lara Shipley,
  2. Aarti Mistry,
  3. Don Sharkey
  1. Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Don Sharkey, Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK; don.sharkey{at}nottingham.ac.uk

Abstract

Objective Therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes.

Design Retrospective cohort study using National Neonatal Research Database and propensity score-matching.

Setting UK neonatal units.

Patients Infants ≥36 weeks gestational age with moderate or severe HIE admitted 2011–2016.

Interventions Birth in non-CC compared with CC.

Main outcome measures Primary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer.

Results 5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth.

Conclusions Almost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.

  • neonatology
  • neurology

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data were extracted and supplied by the NDAU and are available from the corresponding author on reasonable request and with permission of the study team and NDAU.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data were extracted and supplied by the NDAU and are available from the corresponding author on reasonable request and with permission of the study team and NDAU.

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Footnotes

  • Twitter @DrDonSharkey

  • Contributors LS and DS made substantial contributions to the concept, planning, design of the study and acquisition of data. AM and DS collated access to TH data. LS and DS analysed and interpreted the data with support from Professor C Coupland (acknowledgement).

  • Funding This study was partly supported by a University of Nottingham, School of Medicine Impact Funding award.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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