Impact of Education on Hypothermia Delivery during Neonatal Transport

Abstract

Background: Moderate therapeutic hypothermia (TH) initiated within 6 h of life reduces adverse neurodevelopmental outcomes in infants after perinatal hypoxic ischaemic insult. For infants born in non-tertiary centres, TH may be initiated manually en route to a neonatal intensive care unit (NICU). However, both over- and undercooling is reported with this strategy, precluding some infants from the benefits of TH. Objectives: To evaluate the impact of a region-wide educational programme on the safety and efficacy of manual cooling administered by the Wellington Neonatal Transport Service (NeTS). Methods: Clinical records of infants with hypoxic ischaemic encephalopathy (HIE) retrieved by the Wellington NeTS for TH between January 2012 and June 2017 were reviewed retrospectively. Temperature outcomes of infants retrieved before and after the education programme were compared. Results: A total of 101 infants were cooled manually by Wellington NeTS for TH during the study period. Education and training significantly reduced the rate of overcooling to ≤32.0°C (4/43 [9%] vs. 0/58, p = 0.02). However, there was no difference in the proportion of infants who achieved target rectal temperature within 6 h of life (29/43 [65%] vs. 35/58 [60%], p = 0.57). Conclusions: Introduction of a region-wide educational programme may have improved the safety of manual cooling during neonatal transport but it had a negligible impact on its efficacy. The use of servo-controlled cooling during transport should therefore be considered to improve access to the optimal neuroprotective benefits of TH for outborn infants with HIE.

Short-term outcomes of asphyxiated neonates depending on outborn versus inborn status

“…Outborn infants frequently do not have access to cooling within the cri cal me window and are either not offered TH or reach the target temperature later [11,24,25]. Strategies to overcome the delayed TH onset by ac ve or passive cooling prior to arrival at the cooling center require training and bring along reduced efficiency and risk of overcooling [26]. To further inves gate the most severely affected infants -the subgroup receiving TH -we conducted a sensi vity analysis.…”

Cooling strategies during neonatal transport for hypoxic‐ischaemic encephalopathy

“…Many attempts have been made to apply a standardised protocol in the treatment of outborns eligible for therapeutic hypothermia. While outcomes may be influenced by local neonatal transport resources, several studies demonstrated that education and training can improve neonatal outcomes 49,50 . Bellini et al 51 suggested that an experienced transport team can successfully start passive cooling before admission to a referral centre.…”

“…While outcomes may be influenced by local neonatal transport resources, several studies demonstrated that education and training can improve neonatal outcomes. 49,50 Bellini et al 51 suggested that an experienced transport team can successfully start passive cooling before admission to a referral centre. In contrast, Reaney et al 52 stated that passive cooling does not consistently achieve adequate control of body temperature for outborn infants.…”