Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
University of Calgary, Calgary, AB, Canada.
Pediatr Res. 2023 Jul;94(1):321-330. doi: 10.1038/s41390-022-02453-6. Epub 2023 Jan 9.
Therapeutic hypothermia (TH) is the gold-standard treatment for moderate and severe neonatal encephalopathy (NE). Care during TH has implications for long-term outcomes. Outcome variability exists among neonatal intensive care units (NICUs) in Canada, but care variations are not understood well. This study examines variations in care practices for neonates with NE treated with TH in NICUs across Canada.
A non-anonymous, web-based questionnaire was emailed to tertiary NICUs in Canada providing TH for NE to assess care practices during the first days of life and neurodevelopmental follow-up.
Ninety-two percent (24/26) responded. Centres followed national guidelines regarding the use of the modified Sarnat score to assess the initial severity of NE, the need to initiate TH within the first 6 h of birth, and the importance of follow-up. However, other practices varied, including ventilation mode, definition/treatment of hypotension, routine echocardiography, use of sedation, use of electroencephalogram (EEG), MRI timing, placental analysis, and follow-up duration.
NICUs across Canada follow available national guidelines, but variations exist in practices for managing NE during TH. Development and implementation of a consensus-based care bundle for neonates during TH may reduce practice variability and improve outcomes.
This survey describes the current HIE care practices and variation among tertiary centres in Canada. Variations exist in the care of neonates with NE treated with TH in NICUs across Canada. This paper Identifies areas of variation that are not discussed in detail in the national guidelines and will help to set up quality improvement initiatives. Elucidating the variation in care practices calls for the creation and implementation of a national, consensus-based care bundle, with the objective to improve the outcomes of these critically ill neonates.
治疗性低体温（TH）是中重度新生儿脑病（NE）的标准治疗方法。TH 期间的护理对长期结局有影响。加拿大新生儿重症监护病房（NICU）之间存在结局变异性，但护理差异尚不清楚。本研究检查了加拿大各地 NICU 中接受 TH 治疗的 NE 患儿的护理实践差异。
向加拿大提供 TH 治疗 NE 的三级 NICU 发送非匿名网络问卷调查，以评估生命最初几天的护理实践和神经发育随访。
92%（24/26）作出回应。中心遵循国家指南，使用改良 Sarnat 评分评估 NE 的初始严重程度、在出生后 6 小时内开始 TH 的必要性以及随访的重要性。然而，其他做法存在差异，包括通气模式、低血压的定义/治疗、常规超声心动图、镇静的使用、脑电图（EEG）的使用、MRI 时机、胎盘分析和随访时间。
加拿大的 NICU 遵循现有的国家指南，但在 TH 期间管理 NE 的实践存在差异。为 TH 期间的新生儿制定和实施基于共识的护理套餐可能会减少实践变异性并改善结局。
本调查描述了加拿大三级中心目前的 HIE 护理实践和变异性。加拿大各地 NICU 中接受 TH 治疗的 NE 患儿的护理存在差异。本文确定了国家指南中未详细讨论的差异领域，并将有助于制定质量改进计划。阐明护理实践的差异需要创建和实施国家共识护理套餐，目标是改善这些危重新生儿的结局。
