Lumba Rishi, Mally Pradeep, Espiritu Michael, Wachtel Elena V
Pediatrics, Division of Neonatology, New York University Medical Center, New York, NY, USA.
J Perinat Med. 2019 Apr 24;47(3):365-369. doi: 10.1515/jpm-2018-0302.
Background Earlier initiation of therapeutic hypothermia in term infants with hypoxic-ischemic encephalopathy has been shown to improve neurological outcomes. The objective of the study was to compare safety and effectiveness of servo-controlled active vs. passive cooling used during neonatal transport in achieving target core temperature. Methods We undertook a prospective cohort quality improvement study with historic controls of therapeutic hypothermia during transport. Primary outcome measures were analyzed: time to cool after initiation of transport, time to achieve target temperature from birth and temperature on arrival to cooling centers. Safety was assessed by group comparison of vital signs, diagnosis of persistent pulmonary hypertension (PPHN) and coagulation profiles on arrival. Results A total of 65 infants were included in the study. Time to cool after initiation of transport and time to achieve target temperature from birth were statistically significantly shorter in the actively cooled group with time reduction of 24% with P<0.01 and 15.6% with P<0.01, respectively. On arrival to our cooling center, we noted a significance difference in the mean core temperature (active 33.8°C vs. passive 35.4°C, P<0.01). Seven percent (2/30) of infants in the passively cooled group were overcooled (temperature <33°C). Patients in the actively cooled group had significantly lower mean heart rate compared to the passively cooled group. There was no statistically significant difference in diagnosis of PPHN or coagulation profiles on admission. Conclusion Our study indicates that active cooling with a servo-controlled device on neonatal transport is safe and more effective in achieving target temperature compared to passive cooling.
已证明在患有缺氧缺血性脑病的足月儿中更早开始治疗性低温可改善神经学预后。本研究的目的是比较在新生儿转运期间使用伺服控制的主动冷却与被动冷却在达到目标核心温度方面的安全性和有效性。方法：我们进行了一项前瞻性队列质量改进研究，并采用了转运期间治疗性低温的历史对照。分析了主要结局指标：转运开始后降温时间、出生后达到目标温度的时间以及到达冷却中心时的体温。通过对到达时的生命体征、持续性肺动脉高压（PPHN）诊断和凝血指标进行组间比较来评估安全性。结果：共有65名婴儿纳入研究。主动冷却组转运开始后降温时间和出生后达到目标温度的时间在统计学上显著更短，时间分别减少了24%（P<0.01）和15.6%（P<0.01）。到达我们冷却中心时，我们注意到平均核心温度存在显著差异（主动冷却组为33.8°C，被动冷却组为35.4°C，P<0.01）。被动冷却组中有7%（2/30）的婴儿体温过低（体温<33°C）。主动冷却组患者的平均心率明显低于被动冷却组。入院时PPHN诊断或凝血指标方面无统计学显著差异。结论：我们的研究表明，与被动冷却相比，在新生儿转运期间使用伺服控制设备进行主动冷却在达到目标温度方面更安全且更有效。
