Changing clinical characteristics of infants treated for hypoxic-ischaemic encephalopathy in England, Wales and Scotland: a population-based study using the National Neonatal Research Database
Changing clinical characteristics of infants treated for hypoxic-ischaemic encephalopathy in England, Wales and Scotland: a population-based study using the National Neonatal Research Database
Background: therapeutic hypothermia is standard of care for babies with moderate/severe hypoxic-ischaemic encephalopathy and is increasingly used for mild encephalopathy.
Objective: describe temporal trends in the clinical condition of babies diagnosed with hypoxic-ischaemic encephalopathy who received therapeutic hypothermia.
Design: retrospective cohort study using data held in the National Neonatal Research Database.
Setting: National Health Service neonatal units in England, Wales and Scotland.
Patients: infants born from 1 January 2010 to 31 December 2017 with a recorded diagnosis of hypoxic-ischaemic encephalopathy who received therapeutic hypothermia for at least 3 days or died in this period.
Main outcomes: primary outcomes recorded clinical characteristics including umbilical cord pH; Apgar score; newborn resuscitation; seizures and treatment on day 1. Secondary outcomes: recorded hypoxic-ischaemic encephalopathy grade.
Results: 5201 babies with a diagnosis of hypoxic-ischaemic encephalopathy received therapeutic hypothermia or died; annual numbers increased over the study period. A decreasing proportion had clinical characteristics of severe hypoxia ischaemia or a diagnosis of moderate or severe hypoxic-ischaemic encephalopathy, trends were statistically significant and consistent across multiple clinical characteristics used as markers of severity.
Conclusions: treatment with therapeutic hypothermia for hypoxic-ischaemic encephalopathy has increased in England, Scotland and Wales. An increasing proportion of treated infants have a diagnosis of mild hypoxic-ischaemic encephalopathy or have less severe clinical markers of hypoxia. This highlights the importance of determining the role of hypothermia in mild hypoxic-ischaemic encephalopathy. Receipt of therapeutic hypothermia is unlikely to be a useful marker for assessing changes in the incidence of brain injury over time.
neonatology, neurology
501-508
Hage, Lory
d406de14-6142-4ea6-8799-644f01c8ef4d
Jeyakumaran, Dusha
4af51f70-a8d5-42db-a5c9-5dfbf703a274
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Ojha, Shalini
adc62cc2-df92-446f-8ad2-4c0cf006d689
Sharkey, Don
370cb36f-a7f9-45ce-a20d-7c12b6dd9a63
Longford, Nicholas
2f3303da-6aa2-49e7-bb14-df151389aee2
Modi, Neena
78ed7664-587f-4cc5-83c1-7fbb8f7baf31
Battersby, Cheryl
24ba455f-7f54-427c-8732-3007926ee5ce
Gale, Chris
210b7c81-9a39-460a-9ab3-54fe92a69f8e
19 August 2021
Hage, Lory
d406de14-6142-4ea6-8799-644f01c8ef4d
Jeyakumaran, Dusha
4af51f70-a8d5-42db-a5c9-5dfbf703a274
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Ojha, Shalini
adc62cc2-df92-446f-8ad2-4c0cf006d689
Sharkey, Don
370cb36f-a7f9-45ce-a20d-7c12b6dd9a63
Longford, Nicholas
2f3303da-6aa2-49e7-bb14-df151389aee2
Modi, Neena
78ed7664-587f-4cc5-83c1-7fbb8f7baf31
Battersby, Cheryl
24ba455f-7f54-427c-8732-3007926ee5ce
Gale, Chris
210b7c81-9a39-460a-9ab3-54fe92a69f8e
Hage, Lory, Jeyakumaran, Dusha, Dorling, Jon, Ojha, Shalini, Sharkey, Don, Longford, Nicholas, Modi, Neena, Battersby, Cheryl and Gale, Chris
(2021)
Changing clinical characteristics of infants treated for hypoxic-ischaemic encephalopathy in England, Wales and Scotland: a population-based study using the National Neonatal Research Database.
Archives of Disease in Childhood: Fetal and Neonatal Edition, 106 (5), .
(doi:10.1136/archdischild-2020-319685).
Abstract
Background: therapeutic hypothermia is standard of care for babies with moderate/severe hypoxic-ischaemic encephalopathy and is increasingly used for mild encephalopathy.
Objective: describe temporal trends in the clinical condition of babies diagnosed with hypoxic-ischaemic encephalopathy who received therapeutic hypothermia.
Design: retrospective cohort study using data held in the National Neonatal Research Database.
Setting: National Health Service neonatal units in England, Wales and Scotland.
Patients: infants born from 1 January 2010 to 31 December 2017 with a recorded diagnosis of hypoxic-ischaemic encephalopathy who received therapeutic hypothermia for at least 3 days or died in this period.
Main outcomes: primary outcomes recorded clinical characteristics including umbilical cord pH; Apgar score; newborn resuscitation; seizures and treatment on day 1. Secondary outcomes: recorded hypoxic-ischaemic encephalopathy grade.
Results: 5201 babies with a diagnosis of hypoxic-ischaemic encephalopathy received therapeutic hypothermia or died; annual numbers increased over the study period. A decreasing proportion had clinical characteristics of severe hypoxia ischaemia or a diagnosis of moderate or severe hypoxic-ischaemic encephalopathy, trends were statistically significant and consistent across multiple clinical characteristics used as markers of severity.
Conclusions: treatment with therapeutic hypothermia for hypoxic-ischaemic encephalopathy has increased in England, Scotland and Wales. An increasing proportion of treated infants have a diagnosis of mild hypoxic-ischaemic encephalopathy or have less severe clinical markers of hypoxia. This highlights the importance of determining the role of hypothermia in mild hypoxic-ischaemic encephalopathy. Receipt of therapeutic hypothermia is unlikely to be a useful marker for assessing changes in the incidence of brain injury over time.
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More information
Accepted/In Press date: 9 January 2021
e-pub ahead of print date: 4 February 2021
Published date: 19 August 2021
Additional Information:
Funding Information:
Competing interests JD reports grants from NIHR, during the conduct of the study, and grants from NIHR, outside the submitted work. JD was a member of the NIHR HTA General Board (from 2017 to 2018) and the NIHR HTA Maternity, Newborn and Child Health Panel (from 2013 to 2018). JD was also funded by Nutrinia in 2017 and 2018 for part of his salary to work as an expert advisor on a trial of enteral insulin. SO reports grants from the National Institute of Health Research, Medical Research Council, and the Derby Hospitals Charity. DS reports grants from the National Institute for Health Research, Medical Research Council, Engineering and Physical Sciences Research Council, outside the submitted work. He is also a committee member of the NIHR Research for Patient Benefit East Midlands Regional Assessment Panel and a non-executive director of SurePulse Medical. NM reports grants from the Medical Research Council, National Institute of Health Research, March of Dimes, British Heart Foundation, HCA International, Health Data Research UK, Shire Pharmaceuticals, Chiesi Pharmaceuticals, Prolacta Life Sciences and Westminster Children’s Research Fund, outside the submitted work. She is a member of the scientific advisory board of Nestle International. NM led the development of and directs the National Neonatal Research Database. CG reports grants from Medical Research Council, the National Institute for Health Research, the Mason Medical Research Foundation, Rosetrees Foundation and Canadian Institute for Health Research, outside the submitted work; and grants and personal fees to attend an educational conference from Chiesi Pharmaceuticals, outside the submitted work; he is a voluntary, unremunerated member of the Neonatal Data Analysis Unit Steering Board, which oversees the National Neonatal Research Database (NNRD), and is vice-chair of the NIHR Research for Patient Benefit London Regional Assessment Panel.
Keywords:
neonatology, neurology
Identifiers
Local EPrints ID: 485012
URI: http://eprints.soton.ac.uk/id/eprint/485012
ISSN: 1359-2998
PURE UUID: 28f2f422-4ef1-4def-8f5e-5af815d1dc3c
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Date deposited: 28 Nov 2023 17:36
Last modified: 18 Mar 2024 04:16
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Contributors
Author:
Lory Hage
Author:
Dusha Jeyakumaran
Author:
Jon Dorling
Author:
Shalini Ojha
Author:
Don Sharkey
Author:
Nicholas Longford
Author:
Neena Modi
Author:
Cheryl Battersby
Author:
Chris Gale
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