Reducing Time to Initiation of Therapeutic Hypothermia in Inborn Infants with Hypoxic-ischemic Encephalopathy.

INTRODUCTION

Earlier therapeutic hypothermia (TH) is associated with improved neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE). We aimed to increase the percentage of inborn infants with TH initiation before 3 hours from 25% to 75% within 12 months.

METHODS

This project took place at 2 academically affiliated Level III NICUs. We included infants inborn with moderate or severe HIE who met standard criteria for TH. The team developed a driver diagram and process map, which informed interventions. We compared data using descriptive statistics and Statistical Process Control charts.

RESULTS

Of the 70 included infants, 13 were in the baseline period, and 57 were in the implementation and sustainment period. There was a special cause variation that increased the centerline from 25% to 72%. The most common cause of initiation of TH after 3 hours of life was progression from mild to moderate HIE (39%). When infants with progression of encephalopathy were excluded, the central line further increased to 79%. In this refined cohort, the mean percentage of infants with TH initiated before 3 hours was 31%, 76%, and 80% in the baseline, implementation, and sustainment periods, respectively.

CONCLUSIONS

Quality improvement methodology can reduce the time to TH initiation in inborn infants, which is associated with improved neurodevelopmental outcomes. A common reason for delayed TH initiation is progression from mild to moderate encephalopathy.