Document Type
Presentation
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Publication Date
7-28-2024
Abstract
Neonatal Hypoxic Ischemic Encephalopathy (HIE) is a significant cause of mortality and long-term neurodevelopmental disabilities in neonates. Therapeutic hypothermia (TH) is the only standard treatment proven to improve outcomes, provided it is initiated within the first 6 hours following the initial perinatal brain insult. However, the optimal timing within this window, particularly the benefits of starting TH within the first 3 hours versus the 4–6-hour window, remains unclear. This retrospective cohort study aimed to compare the outcomes of infants with moderate to severe HIE who received TH within the first 3 hours of life to those who received it between 3- and 6-hours post-birth.
Data were collected from 318 infants treated for HIE at Thomas Jefferson University Hospital between 2005 and 2021. Key outcomes included death or abnormal findings on brain MRI, with secondary outcomes such as mortality rates and severity of MRI abnormalities. The results showed no significant difference in the primary outcome of death or abnormal MRI findings between the early cooling group (initiated within 3 hours) and the late cooling group (initiated between 3-6 hours). The early cooling group had a lower but not statistically significant rate of severe MRI abnormalities compared to the late cooling group. Sensitivity analyses, including adjustments for out born status and other potential confounders, did not alter these findings.
This study indicates that while early initiation of TH (within 3 hours) does not significantly reduce the risk of death or brain injury compared to initiation within the 3–6-hour window, it underscores the importance of timely diagnosis and initiation of TH within the critical 6-hour period. These findings have substantial public health implications for resource allocation and management, suggesting that the current 6-hour window remains a viable guideline for
Neonatal Hypoxic Ischemic Encephalopathy (HIE) is a significant cause of mortality and long-term neurodevelopmental disabilities in neonates. Therapeutic hypothermia (TH) is the only standard treatment proven to improve outcomes, provided it is initiated within the first 6 hours following the initial perinatal brain insult. However, the optimal timing within this window, particularly the benefits of starting TH within the first 3 hours versus the 4–6-hour window, remains unclear. This retrospective cohort study aimed to compare the outcomes of infants with moderate to severe HIE who received TH within the first 3 hours of life to those who received it between 3- and 6-hours post-birth.
Data were collected from 318 infants treated for HIE at Thomas Jefferson University Hospital between 2005 and 2021. Key outcomes included death or abnormal findings on brain MRI, with secondary outcomes such as mortality rates and severity of MRI abnormalities. The results showed no significant difference in the primary outcome of death or abnormal MRI findings between the early cooling group (initiated within 3 hours) and the late cooling group (initiated between 3-6 hours). The early cooling group had a lower but not statistically significant rate of severe MRI abnormalities compared to the late cooling group. Sensitivity analyses, including adjustments for out born status and other potential confounders, did not alter these findings.
This study indicates that while early initiation of TH (within 3 hours) does not significantly reduce the risk of death or brain injury compared to initiation within the 3–6-hour window, it underscores the importance of timely diagnosis and initiation of TH within the critical 6-hour period. These findings have substantial public health implications for resource allocation and management, suggesting that the current 6-hour window remains a viable guideline for
Neonatal Hypoxic Ischemic Encephalopathy (HIE) is a significant cause of mortality and long-term neurodevelopmental disabilities in neonates. Therapeutic hypothermia (TH) is the only standard treatment proven to improve outcomes, provided it is initiated within the first 6 hours following the initial perinatal brain insult. However, the optimal timing within this window, particularly the benefits of starting TH within the first 3 hours versus the 4–6-hour window, remains unclear. This retrospective cohort study aimed to compare the outcomes of infants with moderate to severe HIE who received TH within the first 3 hours of life to those who received it between 3- and 6-hours post-birth.
Data were collected from 318 infants treated for HIE at Thomas Jefferson University Hospital between 2005 and 2021. Key outcomes included death or abnormal findings on brain MRI, with secondary outcomes such as mortality rates and severity of MRI abnormalities. The results showed no significant difference in the primary outcome of death or abnormal MRI findings between the early cooling group (initiated within 3 hours) and the late cooling group (initiated between 3-6 hours). The early cooling group had a lower but not statistically significant rate of severe MRI abnormalities compared to the late cooling group. Sensitivity analyses, including adjustments for out born status and other potential confounders, did not alter these findings.
This study indicates that while early initiation of TH (within 3 hours) does not significantly reduce the risk of death or brain injury compared to initiation within the 3–6-hour window, it underscores the importance of timely diagnosis and initiation of TH within the critical 6-hour period. These findings have substantial public health implications for resource allocation and management, suggesting that the current 6-hour window remains a viable guideline for initiating TH in neonates with HIE. Further prospective studies are needed to conclusively determine if any additional benefits exist for early initiation of TH.
Lay Summary
Neonatal Hypoxic Ischemic Encephalopathy (HIE) is a serious brain injury in newborns caused by lack of oxygen delivery to brain around the time of delivery. HIE affects about 1.5-1.7 per 1000 live births annually in the U.S. and can lead to long term issues like cerebral palsy and developmental delays. Therapeutic hypothermia (TH), lowering the body temperature to protect the brain, is the standard treatment and has shown to improve rate of death and long-term neurological effects when started within first 6 hours of life. Not all hospitals can provide it promptly and affected newborns need to be transferred to a center equipped with a level of neonatal ICU (NICU) within the first 6 hours of life which constraints healthcare resources. It is currently unknown whether starting TH in the first 3 hours of life has an additional benefit. Our study compared whether starting TH in the first 3 hours of life versus between 3 and 6 hours of life has an added short-term benefit to rate of death or severity of brain injury on brain MRI. We did not find any benefit to starting TH early within the 6-hour window after birth. Reassurance that earlier initiation of therapeutic hypothermia might not improve neurodevelopmental outcomes can result in more time to serially examine newborns to establish the diagnosis of HIE. Training healthcare providers to recognize and promptly manage hypoxic-ischemic encephalopathy is crucial. Additionally, efforts should be made to streamline the referral and transport processes to specialized centers where therapeutic hypothermia can be administered.
Recommended Citation
Mishra, MD, Priya, "Timing of Initiation of Therapeutic Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy: A Pulblic Health Perspective" (2024). Master of Public Health Capstone Presentations. Presentation 557.
https://jdc.jefferson.edu/mphcapstone_presentation/557
Language
English
Comments
Presentation: 4:53
Poster attached as supplemental file below