TY - JOUR
T1 - Therapeutic Hypothermia in Transport Permits Earlier Treatment Regardless of Transfer Distance
AU - Leon, Rachel L.
AU - Krause, Katherine E.
AU - Sides, Rebecca S.
AU - Koch, Mary Beth
AU - Trautman, Michael S.
AU - Mietzsch, Ulrike
N1 - Publisher Copyright:
© 2022 American Institute of Physics Inc.. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Objective Therapeutic hypothermia (TH) is currently the only effective therapy available to improve outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and has maximal effect when initiated within 6 hours of birth. Neonates affected by HIE are commonly born outside of cooling centers and transport is a barrier to timely initiation. In this study, we sought to determine if the initiation of servo-controlled TH in transport allowed neonates to reach target temperature earlier, without a significant delay in the transfer process, for both local and long-distance transport. Study Design In this single-center cohort study of neonates referred to a level IV neonatal intensive care unit for TH, we determined the chronologic age at which target temperature was reached for those cooled in transport. Short-term outcome measures were assessed, including survival, incidence of electrographic seizures, discharge feeding method, and length of hospitalization. Results In a study population of 85 neonates, those receiving TH during transport (n = 23), achieved target temperature (33-34°C) 77 minutes sooner (230 ± 71 vs. 307 ± 79 minutes of life (MOL); p < 0.001). Locally transported neonates (<15 miles) achieved target temperature 69 minutes earlier (215 ± 48 vs. 284 ± 74 MOL; p < 0.01). TH during long-distance transports allowed neonates to reach target temperature 81 minutes sooner (213 ± 85 vs. 294 ± 79 MOL; p < 0.01). Infants who were cooled in transport discharged 4 days earlier (13.7 ± 8 vs. 17.8 ± 13 days; p = 0.18) and showed a significantly higher rate of oral feeding at discharge (95 vs. 71%; p = 0.03). Conclusion For those starting TH in transport, time to target temperature was decreased. In our cohort, cooling in transport was associated with improved short-term outcomes, although additional studies are needed to correlate these findings with long-term outcomes. Key Points Therapeutic hypothermia started during transport allows shorter time to target temperature. Transfer was minimally delayed by starting cooling in transport. Cooling in transport was associated with increased rate of oral feeding at hospital discharge.
AB - Objective Therapeutic hypothermia (TH) is currently the only effective therapy available to improve outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and has maximal effect when initiated within 6 hours of birth. Neonates affected by HIE are commonly born outside of cooling centers and transport is a barrier to timely initiation. In this study, we sought to determine if the initiation of servo-controlled TH in transport allowed neonates to reach target temperature earlier, without a significant delay in the transfer process, for both local and long-distance transport. Study Design In this single-center cohort study of neonates referred to a level IV neonatal intensive care unit for TH, we determined the chronologic age at which target temperature was reached for those cooled in transport. Short-term outcome measures were assessed, including survival, incidence of electrographic seizures, discharge feeding method, and length of hospitalization. Results In a study population of 85 neonates, those receiving TH during transport (n = 23), achieved target temperature (33-34°C) 77 minutes sooner (230 ± 71 vs. 307 ± 79 minutes of life (MOL); p < 0.001). Locally transported neonates (<15 miles) achieved target temperature 69 minutes earlier (215 ± 48 vs. 284 ± 74 MOL; p < 0.01). TH during long-distance transports allowed neonates to reach target temperature 81 minutes sooner (213 ± 85 vs. 294 ± 79 MOL; p < 0.01). Infants who were cooled in transport discharged 4 days earlier (13.7 ± 8 vs. 17.8 ± 13 days; p = 0.18) and showed a significantly higher rate of oral feeding at discharge (95 vs. 71%; p = 0.03). Conclusion For those starting TH in transport, time to target temperature was decreased. In our cohort, cooling in transport was associated with improved short-term outcomes, although additional studies are needed to correlate these findings with long-term outcomes. Key Points Therapeutic hypothermia started during transport allows shorter time to target temperature. Transfer was minimally delayed by starting cooling in transport. Cooling in transport was associated with increased rate of oral feeding at hospital discharge.
KW - active cooling
KW - birth asphyxia
KW - birth depression
KW - hypoxic-ischemic encephalopathy
KW - neonatal transport
KW - therapeutic hypothermia
KW - transport cooling
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U2 - 10.1055/s-0040-1718372
DO - 10.1055/s-0040-1718372
M3 - Article
C2 - 33053593
AN - SCOPUS:85094114197
SN - 0735-1631
VL - 39
SP - 633
EP - 639
JO - American Journal of Perinatology
JF - American Journal of Perinatology
IS - 6
ER -