Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK

Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal uni...

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Published in	Archives of disease in childhood. Fetal and neonatal edition Vol. 103; no. 4; pp. F388 - F390
Main Authors	Oliveira, Vânia, Singhvi, Dev Prya, Montaldo, Paolo, Lally, Peter J, Mendoza, Josephine, Manerkar, Swati, Shankaran, Seetha, Thayyil, Sudhin
Format	Journal Article
Language	English
Published	England BMJ Publishing Group LTD 01.07.2018
Subjects	Anesthesia Asphyxia Neonatorum - complications Babies Clinical decision making Cooling Decision making Developmental Disabilities - prevention & control Enteral nutrition Epidemiology Guideline Adherence - standards Humans Hypothermia Hypothermia, Induced Hypoxia-Ischemia, Brain - therapy Infant, Newborn Infants Newborn babies United Kingdom United Kingdom > UK therapeutic hypothermia neonatal encephalopathy
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Abstract	Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal units contacted, 68 were cooling centres. We received 54 responses (79%) and included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33–34°C core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hours. Babies were ventilated for cooling in two (6%) units and 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in eight (22%) units. MRI and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively. Further research is necessary to ensure optimal neuroprotection in mild encephalopathy.
AbstractList	Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal units contacted, 68 were cooling centres. We received 54 responses (79%) and included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33–34°C core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hours. Babies were ventilated for cooling in two (6%) units and 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in eight (22%) units. MRI and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively. Further research is necessary to ensure optimal neuroprotection in mild encephalopathy. Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal units contacted, 68 were cooling centres. We received 54 responses (79%) and included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33-34°C core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hours. Babies were ventilated for cooling in two (6%) units and 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in eight (22%) units. MRI and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively. Further research is necessary to ensure optimal neuroprotection in mild encephalopathy.Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal units contacted, 68 were cooling centres. We received 54 responses (79%) and included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33-34°C core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hours. Babies were ventilated for cooling in two (6%) units and 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in eight (22%) units. MRI and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively. Further research is necessary to ensure optimal neuroprotection in mild encephalopathy.
Author	Shankaran, Seetha Oliveira, Vânia Manerkar, Swati Thayyil, Sudhin Montaldo, Paolo Singhvi, Dev Prya Lally, Peter J Mendoza, Josephine
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Cites_doi	10.1001/archneur.1976.00500100030012 10.1111/jpc.13378 10.1016/j.neuroscience.2015.12.046 10.1002/14651858.CD003311.pub3 10.1136/archdischild-2017-313321
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References_xml	– volume: 271678X start-page: 17707671 year: 2017 article-title: How long is sufficient for optimal neuroprotection with cerebral cooling after ischemia in fetal sheep? publication-title: J Cereb Blood Flow Metab – volume: 33 start-page: 696 year: 1976 article-title: Neonatal encephalopathy following fetal distress publication-title: Arch Neurol doi: 10.1001/archneur.1976.00500100030012 – volume: 53 start-page: 295 year: 2017 article-title: Eligibility criteria for therapeutic hypothermia: From trials to clinical practice publication-title: J Paediatr Child Health doi: 10.1111/jpc.13378 – year: 2017 article-title: Residual brain injury after early discontinuation of cooling therapy in mild neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed publication-title: In Press – volume: 1 start-page: CD003311 year: 2013 article-title: Cooling for newborns with hypoxic ischaemic encephalopathy publication-title: Cochrane Database Syst Rev – volume: 316 start-page: 296 year: 2016 article-title: White matter apoptosis is increased by delayed hypothermia and rewarming in a neonatal piglet model of hypoxic ischemic encephalopathy publication-title: Neuroscience doi: 10.1016/j.neuroscience.2015.12.046 – ident: 2020061507350661000_103.4.F388.7 doi: 10.1001/archneur.1976.00500100030012 – ident: 2020061507350661000_103.4.F388.3 doi: 10.1002/14651858.CD003311.pub3 – volume: 271678X start-page: 17707671 year: 2017 ident: 2020061507350661000_103.4.F388.5 article-title: How long is sufficient for optimal neuroprotection with cerebral cooling after ischemia in fetal sheep? publication-title: J Cereb Blood Flow Metab – ident: 2020061507350661000_103.4.F388.1 – ident: 2020061507350661000_103.4.F388.6 doi: 10.1136/archdischild-2017-313321 – volume: 53 start-page: 295 year: 2017 ident: 2020061507350661000_103.4.F388.2 article-title: Eligibility criteria for therapeutic hypothermia: From trials to clinical practice publication-title: J Paediatr Child Health doi: 10.1111/jpc.13378 – volume: 316 start-page: 296 year: 2016 ident: 2020061507350661000_103.4.F388.4 article-title: White matter apoptosis is increased by delayed hypothermia and rewarming in a neonatal piglet model of hypoxic ischemic encephalopathy publication-title: Neuroscience doi: 10.1016/j.neuroscience.2015.12.046
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SubjectTerms	Anesthesia Asphyxia Neonatorum - complications Babies Clinical decision making Cooling Decision making Developmental Disabilities - prevention & control Enteral nutrition Epidemiology Guideline Adherence - standards Humans Hypothermia Hypothermia, Induced Hypoxia-Ischemia, Brain - therapy Infant, Newborn Infants Newborn babies United Kingdom
Title	Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK
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