Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Pediatr Neurol. 2019 Dec;101:64-70. doi: 10.1016/j.pediatrneurol.2019.02.023. Epub 2019 Mar 11.
Despite the introduction of therapeutic hypothermia, infants with moderate-to-severe hypoxic-ischemic encephalopathy remain at risk of mortality and morbidity. A dedicated service with standardized management protocols and improved communication may help improve care. We aimed to evaluate the impact of a dedicated neonatal neurocritical care service on short-term outcomes in infants with hypoxic-ischemic encephalopathy.
We performed a retrospective cohort study (July 2008 to December 2017) on term and near-term infants admitted to two tertiary neonatal intensive care units with moderate-to-severe hypoxic-ischemic encephalopathy, before and after neonatal neurocritical care service implementation. The primary outcome was brain magnetic resonance imaging findings consistent with those of hypoxic-ischemic encephalopathy. Secondary outcomes included the cooling initiation rate, hospital stay duration, antiseizure medication use, and inotrope use. Regression analysis and interrupted time series analysis were performed after adjusting for confounding factors.
In total, 216 infants with moderate-to-severe hypoxic-ischemic encephalopathy were analyzed-109 before and 107 after neonatal neurocritical care implementation. After adjusting for confounding factors, there was a significant reduction in primary outcomes (adjusted odds ratio: 0.3, confidence interval: 0.15 to 0.57, P < 0.001) after neonatal neurocritical care implementation. Average hospital stay duration reduced by 5.2 days per infant (P = 0.03), identification of eligible infants for cooling improved (P < 0.001), antiseizure medication use reduced (P = 0.001), and early inotropes use reduced (P = 0.04).
Implementation of a neonatal neurocritical care service associated with decreased brain injury shortened the hospital stay duration and improved the care of infants with moderate-to-severe hypoxic-ischemic encephalopathy.
尽管采用了治疗性低温疗法，患有中重度缺氧缺血性脑病的婴儿仍然存在死亡和发病的风险。配备标准化管理方案和改善沟通的专门服务可能有助于改善护理。我们旨在评估专门的新生儿神经重症监护服务对患有缺氧缺血性脑病的婴儿短期结局的影响。
我们对在两家三级新生儿重症监护病房接受治疗的具有中重度缺氧缺血性脑病的足月和近足月婴儿进行了回顾性队列研究（2008 年 7 月至 2017 年 12 月），在实施新生儿神经重症监护服务前后进行了研究。主要结局是与缺氧缺血性脑病一致的脑磁共振成像发现。次要结局包括冷却启动率、住院时间、抗癫痫药物使用和血管加压素使用。在调整混杂因素后，进行了回归分析和中断时间序列分析。
共分析了 216 例中重度缺氧缺血性脑病婴儿，其中 109 例在新生儿神经重症监护实施前，107 例在新生儿神经重症监护实施后。在调整混杂因素后，新生儿神经重症监护实施后主要结局显著减少（调整比值比：0.3，置信区间：0.15 至 0.57，P<0.001）。每个婴儿的平均住院时间减少了 5.2 天（P=0.03），识别出适合冷却的婴儿的比例提高（P<0.001），抗癫痫药物使用减少（P=0.001），早期血管加压素使用减少（P=0.04）。
实施新生儿神经重症监护服务可减少脑损伤，缩短住院时间，并改善中重度缺氧缺血性脑病婴儿的护理。
