Department of Neonatology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Neonatology. 2022;119(6):712-718. doi: 10.1159/000526404. Epub 2022 Oct 6.
We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE).
A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries.
A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH.
This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling" an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported.
本研究旨在明确全球专业人士对治疗性低体温（TH）治疗轻度缺氧缺血性脑病（HIE）患儿的应用的看法和实践情况。
我们于 2020 年 10 月至 2021 年 2 月间通过电子邮件、社交网络和专业群组向 35 个国家的新生儿临床医生发放了一份基于网络的调查（REDCap）。
我们从 35 个国家共获得了 484 份回复，分为中低收入（43%，LMIC）或高收入（57%，HIC）国家。在这 484 名受访者中，有 53%的人会根据具体情况对轻度 HIE 患儿进行 TH 治疗，只有 25%的人从不降温。来自 LMIC 的临床医生更倾向于常规对轻度 HIE 患儿进行 TH 治疗（25%比 HIC 的 16%，p<0.05），并制定了 TH 治疗的单位方案（50%比 HIC 的 26%，p<0.05），更倾向于使用辅助工具，如 aEEG（49%比 HIC 的 32%，p<0.001）、进行 TH 后 MRI 检查（48%比 HIC 的 40%，p<0.05），而较少将神经检查作为 HIE 严重程度分级工具（80%比 HIC 的 95%，p<0.001）。大多数受访者（91%）会支持一项足够大的随机对照试验，以研究 TH 治疗轻度 HIE 后的神经发育结局。
这是第一项关于轻度 HIE 中 TH 治疗的全球意见调查。绝大多数专业人士会考虑对轻度 HIE 患儿进行“降温”，但来自 LMIC 的受访者更倾向于常规对轻度 HIE 患儿进行降温，并使用辅助工具进行诊断和随访。目前实践存在广泛的异质性，迫切需要和广泛支持设计一项足够大的 RCT 来研究神经发育结局。
