57: Therapeutic Hypothermia (TH) for Newborns with Hypoxic-Ischemic Encephalopathy (HIE): Audit of the Edmonton Experience

Abstract

Background: TH use within 6 h of birth in newborns with HIE reduces the risk of death and neurologic impairment. The Northern Alberta Neonatal program provides a regionalized service covering a catchment area of 440,000 square kilometers. TH became a standard of care in Edmonton since July 2006. Objectives: Audit the implementation of TH for HIE in a regionalized setting including initiation in referral centres from July 2006 to September 2013. Design/Methods: This is a prospective review of newborns ≥35 weeks with HIE and <6 h old on initiation of TH . A stepwise protocol of a qualifying perinatal event (one of acidosis [pH <7.0 or BE ≥-16 by arterial cord or gas ≤1 h of age], Apgar score [≤5 at 10'] or continued resuscitation at 10') followed by an abnormal neurological exam of moderate or severe encephalopathy. Amplitude integrated electroencephalogram was used as an adjunct to clinical decision making. From July 2006 to April 2007 TH was initiated only at level 3 centers and thereafter passive cooling was started at the referring centre and continued actively by the neonatal transport team, using gel packs, en-route to level 3 centers. TH was continued for 72 h. Results: Of 169 eligible newborns, 123 (73%) were cooled, only one of 15 (7%) prior to 2007 vs 122 of 154 (79%) after. Ninety-three of 123 (76%) were outborn and 77 of 93 (83%) were cooled on transport. 116 of 123 (94%) had at least one perinatal event (70% had acidosis, 68% had Apgar ≤5 at 10', and 81% required resuscitation at 10'). All had abnormal neurologic exam and 20 of 123 (16%) died. All surviving newborns are being followed for neurodevelopmental outcomes. Conclusions: Despite the vast catchment area and transport time, sometimes >6 h, the initiation of TH for newborns with HIE prior and during transport could be achieved in a timely manner in >80% of cases. Recognition and timely referral is crucial in reducing risk of mortality and morbidity in these newborns. (Table presented) .