AI Article Synopsis
- Therapeutic hypothermia (TH) is the standard treatment for moderate to severe neonatal encephalopathy (NE), but there are notable variations in care practices across neonatal intensive care units (NICUs) in Canada, potentially affecting long-term outcomes.
- A survey sent to tertiary NICUs in Canada received a 92% response rate and indicated that while most centers adhere to national guidelines for certain initial assessments and protocols, significant differences exist in areas like ventilation, hypotension treatment, and follow-up practices.
- The findings highlight the need for a consensus-based care bundle to standardize practices during TH, which could enhance care quality and improve outcomes for neonates suffering from NE.
Article Abstract
Background: Therapeutic hypothermia (TH) is the gold-standard treatment for moderate and severe neonatal encephalopathy (NE). Care during TH has implications for long-term outcomes. Outcome variability exists among neonatal intensive care units (NICUs) in Canada, but care variations are not understood well. This study examines variations in care practices for neonates with NE treated with TH in NICUs across Canada.
Methods: A non-anonymous, web-based questionnaire was emailed to tertiary NICUs in Canada providing TH for NE to assess care practices during the first days of life and neurodevelopmental follow-up.
Results: Ninety-two percent (24/26) responded. Centres followed national guidelines regarding the use of the modified Sarnat score to assess the initial severity of NE, the need to initiate TH within the first 6 h of birth, and the importance of follow-up. However, other practices varied, including ventilation mode, definition/treatment of hypotension, routine echocardiography, use of sedation, use of electroencephalogram (EEG), MRI timing, placental analysis, and follow-up duration.
Conclusions: NICUs across Canada follow available national guidelines, but variations exist in practices for managing NE during TH. Development and implementation of a consensus-based care bundle for neonates during TH may reduce practice variability and improve outcomes.
Impact: This survey describes the current HIE care practices and variation among tertiary centres in Canada. Variations exist in the care of neonates with NE treated with TH in NICUs across Canada. This paper Identifies areas of variation that are not discussed in detail in the national guidelines and will help to set up quality improvement initiatives. Elucidating the variation in care practices calls for the creation and implementation of a national, consensus-based care bundle, with the objective to improve the outcomes of these critically ill neonates.
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| http://dx.doi.org/10.1038/s41390-022-02453-6 | DOI Listing |
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