瑞士单位治疗患有缺氧缺血性脑病的新生儿的过程差异及其对短期结果的影响。
Process variations between Swiss units treating neonates with hypoxic-ischemic encephalopathy and their effect on short-term outcome.
机构信息
Newborn Research, Department of Neonatology, University and University Hospital Zurich, Zurich, Switzerland.
Division of Neonatology and Pediatric Intensive Care, Children's University Hospital Zurich, Zurich, Switzerland.
出版信息
J Perinatol. 2021 Dec;41(12):2804-2812. doi: 10.1038/s41372-021-01156-w. Epub 2021 Jul 21.
OBJECTIVE
To compare therapeutic hypothermia (TH) treatment of term and near-term neonates with hypoxic-ischemic encephalopathy (HIE) between neonatal units.
STUDY DESIGN
Population-based, retrospective analysis of TH initiation and maintenance, and of diagnostic imaging. The comparison between units was based on crude data analysis, indirect standardization, and adjusted logistic regression.
RESULTS
TH was provided to 570 neonates with HIE between 2011 and 2018 in 10 Swiss units. We excluded 121 off-protocol cooled neonates to avoid selection bias. Of the remaining 449 neonates, the outcome was favorable to international benchmarks, but there were large unit-to-unit variations in baseline perinatal data and TH management. A total of 5% neonates did not reach target temperature within 7 h (3-10% between units), and 29% experienced over- or undercooling (0-38%).
CONCLUSION
Although the neonates had favorable short-term outcomes, areas for improvement remain for Swiss units in both process and outcome measures.
目的
比较新生儿单位中治疗性低体温（TH）治疗足月和近足月患有缺氧缺血性脑病（HIE）的新生儿。
研究设计
基于人群的回顾性分析，分析 TH 的启动和维持以及诊断影像学。通过对数据的直接分析、间接标准化和调整后的逻辑回归，对各单位进行比较。
结果
2011 年至 2018 年，10 家瑞士单位共收治了 570 例患有 HIE 的新生儿。为避免选择偏倚，我们排除了 121 例未按方案降温的患儿。在剩余的 449 例患儿中，结局与国际基准一致，但各单位间围产期数据和 TH 管理存在较大差异。共有 5%的患儿在 7 小时内未达到目标体温（3-10%的患儿在各单位之间），29%的患儿出现体温过高或过低（0-38%）。
结论
尽管新生儿的短期结局良好，但瑞士各单位在治疗过程和结局方面仍有改进的空间。
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