Arnaez Juan, García-Alix Alfredo, Arca Gemma, Caserío Sonia, Valverde Eva, Moral M Teresa, Benavente-Fernández Isabel, Lubián-López Simón
1 Unidad de Neonatología, Hospital Universitario de Burgos , Burgos, España, Fundación NeNe, España.
2 Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu , Universitat de Barcelona, Barcelona, España, Fundación NeNe, España.
Ther Hypothermia Temp Manag. 2018 Mar;8(1):24-29. doi: 10.1089/ther.2017.0024. Epub 2017 Aug 11.
Data on the incidence of hypoxic-ischemic encephalopathy (HIE) in the first 6 hours of life together with the implementation of therapeutic hypothermia (TH) are relevant to delineate actions to achieve the lowest rates of neonatal mortality, morbidity, and long-term impact on health associated with HIE. This is population-based national survey study, including newborns ≥35 weeks of gestation with moderate-to-severe HIE from all level III neonatal care units, to provide the incidence of HIE for the period 2012-2013, and the implementation of TH up to June 2015 in Spain. Incidence rate was 0.77 per 1000 live births (95% confidence interval 0.72-0.83). By June 2015, 63% (57/90) of the units had implemented TH; 95% of them performed servo-controlled whole-body TH. For the 2-year period, 86% of the newborns diagnosed with moderate-to-severe HIE received TH. Active TH increased in use from 78% in 2012 to 85% in 2013 (p = 0.01). The main reasons for not cooling were a delay in the diagnosis (31/682) and the fact that the treatment was not offered (20/682). Interhospital patient transfer was performed using passive hypothermia, by appropriately trained personnel in 61% of centers. Eighteen percent of newborns with moderate or severe HIE died, without significant differences between the 2 years. Up-to-date knowledge of the national coverage of neonatal care of infants with HIE in developed countries is a prerequisite to reducing the load of HIE in this area and to facilitating coordinated, eliminate investigation.
出生后首6小时内的缺氧缺血性脑病（HIE）发病率数据以及治疗性低温（TH）的实施情况，对于明确实现与HIE相关的新生儿死亡率、发病率最低水平及对健康的长期影响的行动至关重要。这是一项基于人群的全国性调查研究，纳入了来自所有三级新生儿护理单位、孕周≥35周且患有中重度HIE的新生儿，以提供2012 - 2013年期间西班牙HIE的发病率以及截至2015年6月TH的实施情况。发病率为每1000例活产0.77例（95%置信区间0.72 - 0.83）。截至2015年6月，63%（57/90）的单位实施了TH；其中95%进行了伺服控制的全身TH。在这2年期间，86%被诊断为中重度HIE的新生儿接受了TH。主动TH的使用从2012年的78%增加到2013年的85%（p = 0.01）。未进行降温的主要原因是诊断延迟（31/682）以及未提供该治疗（20/682）。61%的中心由经过适当培训的人员通过被动低温进行院际患者转运。18%的中重度HIE新生儿死亡，2年间无显著差异。了解发达国家HIE婴儿新生儿护理的全国覆盖最新情况，是减轻该领域HIE负担并促进协调、消除调查的前提条件。
