Optimizing therapeutic hypothermia for neonatal encephalopathy

• Published in: Pediatrics (Evanston) Vol. 131; no. 2; p. e591
• Main Authors: Olsen, Steven L, Dejonge, Mitchell, Kline, Alex, Liptsen, Ellina, Song, Dongli, Anderson, Betsi, Mathur, Amit
• Format: Journal Article
• Language: English
• Published: United States 01.02.2013
• Subjects: Cooperative Behavior; Developmental Disabilities - etiology; Developmental Disabilities - mortality; Developmental Disabilities - prevention & control; Electroencephalography - methods; Electroencephalography - standards; Evidence-Based Medicine - methods; Evidence-Based Medicine - standards; Feasibility Studies; Health Plan Implementation - organization & administration; Humans; Hypothermia, Induced - methods; Hypothermia, Induced - standards; Hypoxia-Ischemia, Brain - diagnosis; Hypoxia-Ischemia, Brain - mortality; Hypoxia-Ischemia, Brain - therapy; Infant, Newborn; Intensive Care Units, Neonatal - organization & administration; Intensive Care Units, Neonatal - standards; Interdisciplinary Communication; Monitoring, Physiologic - methods; Monitoring, Physiologic - standards; Pilot Projects; Quality Improvement - organization & administration; Referral and Consultation - organization & administration; Signal Processing, Computer-Assisted; Survival Rate; Transportation of Patients - organization & administration; United States; United States
• ISSN: 1098-4275
• DOI: 10.1542/peds.2012-0891

Therapeutic hypothermia (TH) for neonatal encephalopathy is becoming widely available in clinical practice. The goal of this collaborative was to create and implement an evidence-based standard-of-care approach to neonatal encephalopathy, deliver consistent care, and optimize outcomes. The quality improvement process identified and used the Model for Improvement as a framework for improvement efforts. This was a Vermont Oxford Network Collaborative focused on optimizing TH in the treatment of neonatal encephalopathy. By using an evidence-based approach, Potentially Better Practices were developed by the topic expert, modified by the collaborative, and implemented at each hospital. These included the following: timely identification of at-risk infants, coordination with referring hospitals to ensure TH was available within 6 hours after birth, staff education for both local and referring hospitals, nonsedated MRI, incorporating amplitude-integrated EEG into a TH protocol, and ensuring standard neurodevelopmental follow-up of infants. Each center used these practices to develop a matrix for implementation. Local self-assessments directed the implementation and adaptation of the Potentially Better Practices at each center. Resources, based on common identified barriers, were developed and shared among the group. The implementation of a TH program to improve the consistency of care for patients in NICUs is feasible using standard-quality improvement methodology. The successful introduction of new interventions such as TH to the NICU culture requires a collaborative multidisciplinary team, use of a systematic quality improvement process, and perseverance.