PT - JOURNAL ARTICLE AU - Lara Shipley AU - Aarti Mistry AU - Don Sharkey TI - Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis AID - 10.1136/archdischild-2020-320966 DP - 2022 Jan 01 TA - Archives of Disease in Childhood - Fetal and Neonatal Edition PG - 6--12 VI - 107 IP - 1 4099 - http://fn.bmj.com/content/107/1/6.short 4100 - http://fn.bmj.com/content/107/1/6.full SO - Arch Dis Child Fetal Neonatal Ed2022 Jan 01; 107 AB - 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.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.