Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK.
Academic Neonatal Medicine, Imperial College London, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2021 Sep;106(5):529-534. doi: 10.1136/archdischild-2020-320902. Epub 2021 Mar 8.
Hypoxic-ischaemic encephalopathy (HIE) remains a leading cause of neonatal mortality and neurodisability. We aimed to determine the incidence of HIE and management patterns against national guidelines.
Retrospective cohort study using the National Neonatal Research Database.
Neonatal units in England and Wales.
Infants 34-42 weeks gestational age (GA) with a recorded diagnosis of HIE.
Incidence of HIE, mortality and treatment with therapeutic hypothermia (TH) were the main outcomes. Temporal changes were compared across two epochs (2011-2013 and 2014-2016).
Among 407 462 infants admitted for neonatal care, 12 195 were diagnosed with HIE. 8166 infants ≥36 weeks GA had moderate/severe HIE, 62.1% (n=5069) underwent TH and mortality was 9.3% (n=762). Of infants with mild HIE (n=3394), 30.3% (n=1027) underwent TH and 6 died. In late preterm infants (34-35 weeks GA) with HIE (n=635, 5.2%), 33.1% (n=210) received TH and 13.1% (n=83) died. Between epochs (2011-2013 vs 2014-2016), mortality decreased for infants ≥36 weeks GA with moderate/severe HIE (17.5% vs 12.3%; OR 0.69, 95% CI 0.59 to 0.81, p<0.001). Treatment with TH increased significantly between epochs in infants with mild HIE (24.9% vs 35.8%, p<0.001) and those born late preterm (34.3% vs 46.6%, p=0.002).
Mortality of infants ≥36 weeks GA with moderate/severe HIE has reduced over time, although many infants diagnosed with moderate/severe HIE do not undergo TH. Increasingly, mild HIE and late preterm infants with HIE are undergoing TH, where the evidence base is lacking, highlighting the need for prospective studies to evaluate safety and efficacy in these populations.
缺氧缺血性脑病（HIE）仍然是新生儿死亡和神经发育障碍的主要原因。我们旨在确定 HIE 的发病率，并根据国家指南进行管理。
使用国家新生儿研究数据库进行回顾性队列研究。
英格兰和威尔士的新生儿病房。
胎龄 34-42 周（GA）并记录有 HIE 诊断的婴儿。
HIE 的发病率、死亡率和治疗性低温（TH）的治疗是主要结局。在两个时期（2011-2013 年和 2014-2016 年）比较了时间变化。
在 407462 名接受新生儿护理的婴儿中，有 12195 名被诊断患有 HIE。8166 名≥36 周 GA 的婴儿有中度/重度 HIE，62.1%（n=5069）接受 TH，死亡率为 9.3%（n=762）。轻度 HIE（n=3394）患儿中，30.3%（n=1027）接受 TH，6 人死亡。在晚期早产儿（34-35 周 GA）中患有 HIE（n=635，5.2%），33.1%（n=210）接受 TH，13.1%（n=83）死亡。在两个时期（2011-2013 年与 2014-2016 年）之间，中度/重度 HIE 的≥36 周 GA 婴儿的死亡率下降（17.5% vs 12.3%；OR 0.69，95%CI 0.59 至 0.81，p<0.001）。在轻度 HIE（24.9% vs 35.8%，p<0.001）和晚期早产儿（34.3% vs 46.6%，p=0.002）中，TH 的治疗在两个时期之间显著增加。
随着时间的推移，≥36 周 GA 中度/重度 HIE 婴儿的死亡率有所下降，尽管许多被诊断为中度/重度 HIE 的婴儿未接受 TH。越来越多的轻度 HIE 和患有 HIE 的晚期早产儿接受 TH，而这方面的证据不足，这凸显了需要前瞻性研究来评估这些人群的安全性和疗效。
