Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand,
Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand,
Neonatology. 2019;116(1):20-26. doi: 10.1159/000495688. Epub 2019 Mar 19.
Moderate therapeutic hypothermia (TH) initiated within 6 h of life reduces adverse neurodevelopmental outcomes in infants after perinatal hypoxic ischaemic insult. For infants born in non-tertiary centres, TH may be initiated manually en route to a neonatal intensive care unit (NICU). However, both over- and undercooling is reported with this strategy, precluding some infants from the benefits of TH.
To evaluate the impact of a region-wide educational programme on the safety and efficacy of manual cooling administered by the Wellington Neonatal Transport Service (NeTS).
Clinical records of infants with hypoxic ischaemic encephalopathy (HIE) retrieved by the Wellington NeTS for TH between January 2012 and June 2017 were reviewed retrospectively. Temperature outcomes of infants retrieved before and after the education programme were compared.
A total of 101 infants were cooled manually by Wellington NeTS for TH during the study period. Education and training significantly reduced the rate of overcooling to ≤32.0°C (4/43 [9%] vs. 0/58, p = 0.02). However, there was no difference in the proportion of infants who achieved target rectal temperature within 6 h of life (29/43 [65%] vs. 35/58 [60%], p = 0.57).
Introduction of a region-wide educational programme may have improved the safety of manual cooling during neonatal transport but it had a negligible impact on its efficacy. The use of servo-controlled cooling during transport should therefore be considered to improve access to the optimal neuroprotective benefits of TH for outborn infants with HIE.
围生期缺氧缺血性损伤后，生命早期 6 小时内开始适度的治疗性低温（TH）可降低婴儿的不良神经发育结局。对于在非三级中心出生的婴儿，TH 可能在送往新生儿重症监护病房（NICU）的途中手动开始。然而，这种策略报告了过度和欠冷却，使一些婴儿无法受益于 TH。
评估全地区教育计划对惠灵顿新生儿转运服务（NeTS）实施的手动冷却的安全性和疗效的影响。
通过惠灵顿 NeTS 检索 2012 年 1 月至 2017 年 6 月期间接受 TH 的缺氧缺血性脑病（HIE）婴儿的临床记录，回顾性分析。比较教育计划前后转运婴儿的体温结果。
在研究期间，共有 101 名婴儿通过惠灵顿 NeTS 进行手动 TH 冷却。教育和培训显著降低了冷却至≤32.0°C 的过度冷却率（4/43[9%]与 0/58，p=0.02）。然而，在 6 小时内达到目标直肠温度的婴儿比例没有差异（29/43[65%]与 35/58[60%]，p=0.57）。
引入全地区教育计划可能提高了新生儿转运期间手动冷却的安全性，但对其疗效影响甚微。因此，应考虑在转运过程中使用伺服控制冷却，以改善对外生 HIE 婴儿的 TH 的最佳神经保护益处的获取。
