Factors Influencing Initiation of Therapeutic Hypothermia and Achieving Target Temperature in Neonatal Encephalopathy

Abstract

Delay in initiating therapeutic hypothermia (TH) for neonatal encephalopathy (NE) reduces neuroprotection in experimental studies.[1] We aimed to investigate the factors influencing initiation of TH and achieving target rectal temperature (TT_rec) in NE infants cooled between 2008 and 2010 at Southmead Hospital, Bristol.

Methods: Eligibility criteria from TOBY trial [2]were used to cool NE infants. Data collected on our cohort of 49 babies included weight, sex, gestation, year & place of birth, cardiac compressions, intubation at birth, APGAR scores, cord pH & base deficit, age of initiating TH and reaching TT_rec. Age of initiating TH was classified as early (< 1h) or late (>1h). Time required to reach TT_rec was calculated as difference between age of initiating TH and reaching TT_rec. Logistic regression and multiple linear regression (SPSS v15) were used.

Results: The cohort‘s baseline characteristics were mean (SD) weight (3252g (770)), gestation (39.7 weeks (1.79)) and female (41%). Early initiation of TH was associated with cardiac compressions (60% vs 22%, p=0.02), year of birth (2008 (23%), 2009 (29%), 2010 (47%)) and 10min APGAR score (median (IQR) 5(3,6) vs 6(5,7), p=0.05). Cardiac compressions (OR 4.7, 95% CI (1.24, 17.9)) independently predicted early initiation of TH. Each 100g increase in birth weight significantly increased the time required to reach TT_rec by 7, 95% CI (2, 13) minutes.

Conclusion: Cardiac compressions may increase clinicians‘ awareness of the need for TH and heavier babies require longer periods of cooling to reach target temperature.

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