Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.
Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
Arch Dis Child Fetal Neonatal Ed. 2022 Jan;107(1):6-12. doi: 10.1136/archdischild-2020-320966. Epub 2021 May 27.
Therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes.
Retrospective cohort study using National Neonatal Research Database and propensity score-matching.
UK neonatal units.
Infants ≥36 weeks gestational age with moderate or severe HIE admitted 2011-2016.
Birth in non-CC compared with CC.
Primary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer.
5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth.
Almost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.
主要在三级冷却中心（CC）中进行的治疗性低温（TH）治疗新生儿缺氧缺血性脑病（HIE）可降低死亡率和神经残疾。尚不清楚在非冷却中心（非 CC）中出生，未进行主动 TH 是否会影响短期结局。
使用国家新生儿研究数据库和倾向评分匹配的回顾性队列研究。
英国新生儿病房。
2011-2016 年入院的胎龄≥36 周的中重度 HIE 婴儿。
与 CC 相比，非 CC 出生。
主要结局为无记录癫痫发作的出院存活率。次要结局为转移至 CC 后记录的癫痫发作、死亡率和到达 CC 时的体温。
共纳入 5059 例婴儿，其中 2364 例（46.7%）出生于非 CC。与 CC 出生相比，CC 出生可提高无癫痫发作的生存率（35.1%比 31.8%；比值比 1.15，95%置信区间 1.02 至 1.31；p=0.02）、降低癫痫发作发生率（60.7%比 64.6%；比值比 0.84，95%置信区间 0.75 至 0.95，p=0.007）和相似的死亡率（15.8%比 14.4%；比值比 1.11，95%置信区间 0.93 至 1.31，p=0.20）。仅来自 2 级中心的匹配婴儿有类似的结果，与非 CC 相比，CC 出生与更高的无癫痫发作生存率相关。从非 CC 转至 CC 后（n=2027），1362 例（67.1%）婴儿到达时记录到最佳治疗温度，但只有 259 例（12.7%）婴儿在出生后 6 小时内到达。
近一半的英国 HIE 婴儿出生于非 CC，这与低温治疗效果不佳和无癫痫发作生存率降低有关。在向上转诊前，应考虑在非 CC 医院提供主动 TH。
