The Baby Cooling Project of Japan to Implement Evidence-Based Neonatal Cooling

Abstract

Therapeutic hypothermia was first recommended as a standard of care by international guidelines in 2010. However, at that time, the number of centers capable of providing standard cooling was limited even in Japan. The aim of this project was to implement a nationwide network of evidence-based cooling within 3 years. A taskforce was formed in June 2010 to undergo the primary nationwide practice survey, design of action plans, and the appraisal of interventions by involving all registered level-II/III neonatal intensive care units in Japan. Based on findings from the primary survey, aggressive action plans were introduced that focused on the formulation of clinical recommendations, facilitation of educational events, and opening of an online case registry. Findings from the follow-up survey ( January 2013) were compared with the results from the primary survey ( June 2010). Four workshops and three consensus meetings were held to formulate clinical recommendations, which were followed by the publication of practical textbooks, large-scale education seminars, and implementation of a case registry. A follow-up survey covering 253 units (response rate: 89.1%) showed that cooling centers increased from 89 to 135. Twelve prefectures had no cooling centers in 2010, whereas all 47 prefectures had at least one in 2013. In cooling centers, adherence to the standard cooling protocols and the use of servo-controlled cooling devices improved from 20.7% to 94.7% and from 79.8% to 98.5%, respectively. A rapid improvement in the national provision of evidence-based cooling was achieved. International consensus guidelines coupled with domestic interventions might be effective in changing empirical approaches to evidence-based practice.

Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan

“…Adherence to standard cooling protocols was maintained at a high level in Japan, even after the conclusion of the nationwide implementation campaign that ran between 2010 and 201214. During the first 3 years of the Baby Cooling Register, there was a substantial change in cooling technique from SHC to WBC.…”

“…When TH was newly recommended as a standard of care in 20109, a substantial proportion of Japanese neonatal intensive care centres had already started cooling encephalopathic neonates according to empirically-acquired cooling indications and protocols13. To disseminate evidence-based best practice for TH for newborn infants, a dynamic nationwide campaign was conducted between 2010 and 2012, leading to a dramatic improvement in adherence to the standard cooling criteria and protocol14. The Baby Cooling Registry of Japan was opened in 2012 to disseminate evidence-based cooling practice by monitoring the clinical use of TH, and by giving feedback to participating units.…”

“…To ensure evidence-based best practice, a series of substantive alterations were undertaken in 201014 to coincide with the release of the revised Consensus Statement and Treatment Recommendation on Cardiopulmonary Resuscitation (CoSTR)9. Owing to the nationwide campaign, adherence to evidence-based cooling protocols improved from 20.7% to 94.7% in less than 3 years14.…”