Abstract
Background:
The effect of birth location on hypothermia-related outcomes has not been rigorously examined in the literature. In this study, we determined whether birth location had an impact on the benefits of whole-body cooling to 33.5 °C for 72 h in term infants (n = 208) with hypoxic–ischemic encephalopathy (HIE) who participated in the Neonatal Research Network (NRN) randomized controlled trial.
Methods:
Heterogeneity by birth location was examined with respect to cooling treatment for the 18-mo primary outcomes (death, moderate disability, severe disability) and secondary outcomes (death, components of disability), and in-hospital organ dysfunction. Logistic regression models were used to generate adjusted odds ratios.
Results:
Infants born at a location other than an NRN center (outborn) (n = 93) experienced significant delays in initiation of therapy (mean (SD): 5.5 (1.1) vs. 4.4 (1.2) h), lower baseline temperatures (36.6 (1.2) vs. 37.1 (0.9) °C), and more severe HIE (43 vs. 29%) than infants born in an NRN center (inborn) (n = 115). Maternal education <12 y (50 vs. 14%) and African-American ethnicity (43 vs. 25%) were more common in the inborn group. When adjusted for NRN center and HIE severity, there were no significant differences in 18-mo outcomes or in-hospital organ dysfunction between inborn and outborn infants.
Conclusion:
Although limited by sample size and some differences in baseline characteristics, the study showed that birth location does not appear to modify the treatment effect of hypothermia after HIE.
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Acknowledgements
We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study: NRN Steering Committee Chairs: Alan H. Jobe, University of Cincinnati; Michael S. Caplan, University of Chicago, Pritzker School of Medicine. Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island: William Oh, Betty R. Vohr, Angelita M. Hensman, and Lucy Noel. Case Western Reserve University, Rainbow Babies & Children’s Hospital: Avroy A. Fanaroff, Deanne E. Wilson-Costello, Nancy S. Newman, and Bonnie S. Siner. Cincinnati Children’s Hospital Medical Center, University Hospital and Good Samaritan Hospital: Kurt Schibler, Edward F. Donovan, Jean J. Steichen, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L. Mincey, Jody Hessling, and Teresa L. Gratton. Duke University, School of Medicine University Hospital, Alamance Regional Medical Center, and Durham Regional Hospital: C. Michael Cotten, Ricki F. Goldstein, Kathy J. Auten, and Melody B. Lohmeyer. Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown: Barbara J. Stoll, Lucky Jain, Ira Adams-Chapman, and Ellen C. Hale. Eunice Kennedy Shriver National Institute of Child Health and Human Development: Linda L. Wright and Elizabeth M. McClure. Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services: Brenda B. Poindexter, James A. Lemons, Anna M. Dusick, Lucy C. Miller, Leslie Richard. RTI International: W. Kenneth Poole, Dennis Wallace, Jane Hammond, Betty K. Hastings, Jamie E. Newman, Carolyn M. Petrie Huitema, and Jeanette O’Donnell Auman. Stanford University and Lucile Packard Children’s Hospital: Krisa P. Van Meurs, David K. Stevenson, Susan R. Hintz, William D. Rhine, M. Bethany Ball, Anne M. DeBattista, Barry E. Fleisher, Jean G. Kohn, Joan M. Baran, and Julie C. Lee-Ancajas. University of Alabama at Birmingham Health System and Children’s Hospital of Alabama: Waldemar A. Carlo, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, and Vivien A. Phillips. University of California – San Diego Medical Center and Sharp Mary Birch Hospital for Women and Newborns: Neil N. Finer, Yvonne E. Vaucher, Maynard R. Rasmussen, David Kaegi, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Chris Henderson, and Wade Rich. University of Miami Holtz Children’s Hospital: Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, and Amy Mur Worth. University of Rochester Medical Center Golisano Children’s Hospital: Ronnie Guillet, Dale L. Phelps, Gary J. Myers, Linda J. Reubens, Diane Hust, Julie Babish Johnson, Rosemary L. Jensen, Emily Kushner, Joan Merzbach, and Kelley Yost. University of Texas Southwestern, Medical Center at Dallas Parkland Health & Hospital System and Children’s Medical Center Dallas: Abbot R. Laptook, Pablo J. Sánchez, Walid A. Salhab, R. Sue Broyles, Roy J. Heyne, Susie Madison, Jackie F. Hickman, Gaynelle Hensley, Nancy A. Miller, Alicia Guzman, Janet S. Morgan, Cristin Dooley, Catherine Twell Boatman, Elizabeth Heyne, Linda A. Madden, and Sally S. Adams. University of Texas Health Science Center at Houston, Medical School, Children’s Memorial Hermann Hospital, and Lyndon Baines Johnson General Hospital/Harris County Hospital District: Kathleen A. Kennedy, Esther G. Akpa, Patty A. Cluff, Claudia I. Franco, Anna E. Lis, Georgia E. McDavid, Maegan C. Simmons, Patti L. Pierce Tate, Nora I. Alaniz, Pamela J. Bradt, Magda Cedillo, Susan Dieterich, Terri Major-Kincade, Brenda H. Morris, and Laura L. Whitely. Wayne State University, Hutzel Women’s Hospital and Children’s Hospital of Michigan: Yvette R. Johnson, Geraldine Muran, Deborah Kennedy, and Laura A. Goldston.Yale University, Yale-New Haven Children’s Hospital: Patricia Gettner, Monica Konstantino, JoAnn Poulsen, Elaine Romano, and Joanne Williams. All authors have made substantive intellectual contributions to the study conception and design, acquisition of data, or analysis and interpretation of data. They have all contributed to the drafting of the article or to the critical revision of it for important intellectual content, and have approved the final version to be published. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content. Data collected at participating sites of the NICHD Neonatal Research Network (NRN) were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data for this study. On behalf of the NRN, Abhik Das (DCC principal investigator) and Carla Bann (DCC statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.
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Natarajan, G., Pappas, A., Shankaran, S. et al. Effect of inborn vs. outborn delivery on neurodevelopmental outcomes in infants with hypoxic–ischemic encephalopathy: secondary analyses of the NICHD whole-body cooling trial. Pediatr Res 72, 414–419 (2012). https://doi.org/10.1038/pr.2012.103
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DOI: https://doi.org/10.1038/pr.2012.103
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