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Abstract
Objective Therapeutic hypothermia (TH) commenced soon after birth for neonatal hypoxic ischaemic encephalopathy (HIE) improves survival and reduces neurodisability. Availability of active TH at the place of birth (Immediate-TH) in the UK is unknown.
Design Population-based observational study.
Setting UK maternity centres.
Patients 5 975 056 births from 2011 to 2018.
Intervention methods For each maternity centre, the year active Immediate-TH was available and the annual birth rates were established. Admission temperatures of infants with HIE transferred from non-tertiary centres with and without Immediate-TH were compared.
Main outcome measures Quantify the annual number of births with access to Immediate-TH. Secondary outcomes included temporal changes in Immediate-TH and admission temperatures for infants requiring transfer to tertiary centres.
Results In UK maternity centres, 75 of 194 (38.7%) provided Immediate-TH in 2011 rising to 95 of 192 (49.5%, p=0.003) in 2018 with marked regional variations. In 2011, 394 842 (51.2%) of 771 176 births had no access to Immediate-TH compared with 276 258 (39.3%) of 702 794 births in 2018 (p<0.001). More infants with HIE arrived in the therapeutic temperature range (76.5% vs 67.3%; OR 1.58, 95% CI 1.25 to 2.0, p<0.001) with less overcooling (10.6% vs 14.3%; OR 0.71, 95% CI 0.51 to 0.98, p=0.036) from centres with Immediate-TH compared with those without.
Conclusions Availability of active Immediate-TH has slowly increased although many newborns still have no access and rely on transport team arrival to commence active TH. This is associated with delayed optimal hypothermic management. Provision of Immediate-TH across all units, with appropriate training and support, could improve care of infants with HIE.
- neonatology
- healthcare disparities
- intensive care units, neonatal
- epidemiology
- health services research
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. All National Birth statistics were obtained from publicly available databases. All survey data from UK-NTRC was contributed freely and under consent of each UK Neonatal Transport service. NNRD data extracted and supplied by the Neonatal Data Analysis (NDAU) were available from the corresponding author on reasonable request and with permission of the study team and NDAU.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. All National Birth statistics were obtained from publicly available databases. All survey data from UK-NTRC was contributed freely and under consent of each UK Neonatal Transport service. NNRD data extracted and supplied by the Neonatal Data Analysis (NDAU) were available from the corresponding author on reasonable request and with permission of the study team and NDAU.
Footnotes
Twitter @AartiMistry5, @DrLTurner, @shaliniojha7, @DrDonSharkey
Collaborators On behalf of the UK-NTRC, an affiliated group of the UK-NTG: E Adams, I M Dady, H Darby, S J Davidson, N Davey, N Fowler, C H Harrison, A Jackson, J Madar, A Leslie, S Pattnayak, A Philpott, N Ratnavel, S Rattigan, J Tooley, P Turton, M S Reddy, P Sakhuja, R Tinnion, A Walker and L Watts. Collaborators' affiliations are as follows: Oxford University Hospitals NHS Foundation Trust; Connect North West Neonatal Transport Service, Manchester University NHS Foundation; University Hospitals Plymouth NHS Trust, Plymouth, UK; University Hospitals Southampton NHS Foundation Trust; CenTre Neonatal Transport Service, University Hospitals of Leicester; Embrace Transport service, Sheffield Children’s NHS Trust; Manchester University NHS Foundation Trust; Scottish Specialist Transport and Retrieval Service, Princess Royal Maternity, Glasgow; Kent Neonatal Transport Service, Medway NHS Foundation Trust, Kent; KIDS-Neonatal Transfer Service; London Neonatal Transport Service, Royal London Hospital, Whitechapel, London; Acute Neonatal Transfer Service, East of England; Newborn Emergency Stabilisation and Transport Team, University Hospitals Bristol and Weston Foundation NHS Trust; Northern Neonatal Transport Service; The Grange University Hospital, Cwmbran; London Neonatal Transfer Service, Barts Health NHS Trust, London; Northern Ireland Specialist Transport and Retrieval and University Hospitals Sussex NHS Foundation Trust.
Contributors DS is the guarantor of this study. AM and DS made substantial contributions to the concept, planning, design of the study and acquisition of data. LS and DS collated the secondary outcome data from the NNRD. The UK Neonatal Transport Research Collaborative (UK-NTRC) helped identify centre equipment access and revised the final manuscript. AM, LS, SO and DS assisted in drafting and editing the manuscript. All authors approved the final version for publication.
Funding AM was part of the project funded by the National Institute for Health Research (NIHR) i4i programme (II-LA-0715-20003) and DS was a co-investigator on the same award.
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Competing interests None declared.
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