TY - JOUR
T1 - "Mild'' Hypoxic-Ischaemic Encephalopathy and Therapeutic Hypothermia
T2 - A Survey of Clinical Practice and Opinion from 35 Countries
AU - Singla, Mani
AU - Chalak, Lina
AU - Kumar, Kishore
AU - Hayakawa, Masahiro
AU - Mehta, Shailender
AU - Neoh, Siew Hong
AU - Kitsommart, Ratchada
AU - Yuan, Yuan
AU - Zhang, Huayan
AU - Shah, Prakesh S.
AU - Smyth, John
AU - Wandita, Setya
AU - Yeo, Kee Thai
AU - Lim, Gina
AU - Oei, Ju Lee
N1 - Publisher Copyright:
© 2022
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Introduction: We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE). Methods: A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries. Results: A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH. Conclusions: This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling"an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported.
AB - Introduction: We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE). Methods: A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries. Results: A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH. Conclusions: This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling"an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported.
KW - Mild hypoxic-ischaemic encephalopathy
KW - Neonatal encephalopathy
KW - Perinatal asphyxia
KW - Survey
KW - Therapeutic hypothermia
UR - http://www.scopus.com/inward/record.url?scp=85141281450&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141281450&partnerID=8YFLogxK
U2 - 10.1159/000526404
DO - 10.1159/000526404
M3 - Article
C2 - 36202069
AN - SCOPUS:85141281450
SN - 1661-7800
VL - 119
SP - 712
EP - 718
JO - Neonatology
JF - Neonatology
IS - 6
ER -