Neonatal Intensive Care Medicine, Port-Royal Hospital, APHP, 75014, Paris, France.
SMUR Pédiatrique 93, APHP, 93100, Montreuil, France.
Eur J Pediatr. 2024 Oct;183(10):4259-4264. doi: 10.1007/s00431-024-05691-4. Epub 2024 Jul 19.
The purpose of this paper is to compare the achievement of target temperature and the short-term neurological outcome according to the use of servo-controlled hypothermia in transport. This is a monocentric retrospective observational before-and-after uncontrolled study of newborns transported for neonatal encephalopathy. The first group was transported from 01/01/2019 to 12/31/2019 in passive hypothermia and the second group from 01/01/2021 to 12/31/2021 in controlled hypothermia. We included patients who had a total of 72 h of servo-controlled therapeutic hypothermia (CTH). We excluded those who had no or less than 72 h of CTH. There were 33 children transported in passive hypothermia in 2019 and 23 children transported in CTH in 2021. There were 9/28 (32%) patients in 2019 who reached the target temperature on arrival at the NICU compared with 20/20 (100%) in 2021 (p value < 0.01). There was a trend towards earlier age of therapeutic hypothermia if started in transport: 3.1 h ± 1.0 vs 4.0 h ± 2.4 for passive hypothermia (p value 0.07). There was no difference in age of arrival in NICU (4.0 h ± 1.2 with CTH vs 3.8 h ± 2.2 without CTH). We found no difference in short-term outcome (survival, abnormal MRI, seizures on EEG) between the two groups.
The use of servo-controlled therapeutic hypothermia makes it possible to reach the temperature target, without increasing the age of arrival in the NICU.
• CTH is rarely used during transport in France even if passive hypothermia rarely reaches temperature target, inducing overcooling and hyperthermia.
• This study shows better temperature control on arrival in the NICU with CTH compared to passive hypothermia, with no increase in arrival time.
本研究旨在比较使用伺服控制降温在转运过程中对目标温度的实现和短期神经结局的影响。这是一项针对新生儿脑病转运的单中心回顾性观察性前后对照研究。第一组在 2019 年 1 月 1 日至 2019 年 12 月 31 日期间采用被动降温进行转运，第二组在 2021 年 1 月 1 日至 2021 年 12 月 31 日期间采用主动降温进行转运。我们纳入了接受总共 72 小时伺服控制治疗性降温（CTH）的患者。排除了那些没有或少于 72 小时 CTH 的患者。2019 年有 33 名患儿在被动降温中转运，2021 年有 23 名患儿在 CTH 中转运。2019 年到达新生儿重症监护病房（NICU）时达到目标温度的患者有 9/28（32%），而 2021 年达到目标温度的患者有 20/20（100%）（p 值<0.01）。如果在转运期间开始治疗性降温，到达 NICU 的年龄有提前的趋势：被动降温组为 3.1 小时±1.0 小时，而 CTH 组为 4.0 小时±2.4 小时（p 值为 0.07）。两组到达 NICU 的年龄没有差异（CTH 组为 4.0 小时±1.2 小时，无 CTH 组为 3.8 小时±2.2 小时）。两组的短期结局（存活率、异常 MRI、脑电图上的癫痫发作）无差异。
使用伺服控制治疗性降温可达到温度目标，而不会增加到达 NICU 的年龄。
