The impact of a register on the management of neonatal cooling in Switzerland

Brotschi, Barbara; Grass, Beate; Ramos, Gabriel F.; Beck, Ingrid; Held, Ulrike; Hagmann, Cornelia; Meyer, P; Zeilinger, G; Schulzke, Sven; Wellmann, Sven; Wagner, B. P.; Daetwyler, Karin; Nelle, Mathias; Bär, W.; Scharrer, B; Jf, Tolsa; Ac, Truttmann; Schneider, J; Pfister, Riccardo; Berger, TM; Fontana, Margherita; Micallef, John P.; Birkenmayer, A; Bucher, H. U.; Natalucci, Giancarlo; Adams, Mark; Frey, Bernhard; Bernet,; Latal, Bea

doi:10.1016/j.earlhumdev.2015.02.009

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…The generalizability of our results is limited due to the relatively small sample size. We focused on the predictive strength of clinical examinations (daily Sarnat score) with almost no missing data in the National Asphyxia and Cooling Register [10]. Therefore, the evolution of encephalopathy during TH is a valuable clinical outcome predictor in our setting.…”

Section: Discussionmentioning

confidence: 99%

“…This is a retrospective analysis of prospectively collected data of a multicenter cohort study including 174 neonates (≥35 0/7 weeks of gestational age) with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated within 6 h of birth at 33.0-34.0 °C core temperature (whole-body cooling with ice gel packs or servo coolers) and continued for 72 h according to the national guidelines for neonates with HIE published previously [9,10]. Maternal and neonatal demographics, perinatal data, clinical presentation and follow-up data were collected from the entries in the Swiss National Asphyxia and Cooling Register and amended by review of the maternal and neonatal charts as appropriate.…”

Section: Methodsmentioning

confidence: 99%

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Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Grass

Scheidegger

Latal

et al. 2020

Journal of Perinatal Medicine

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ObjectivesTo evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18–24 months.MethodsThis is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18–24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up.ResultsOne hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18–24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051–0.271] for an unfavorable outcome at 18–24 months.ConclusionShort-term neurological improvement predicts neurodevelopmental outcome at 18–24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Grass

Scheidegger

Latal

et al. 2020

Journal of Perinatal Medicine

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“…The rate of neonatal seizures is higher in our sample (50.1%) compared with those from other studies: 31.6%, 10 41.1%, 12 44.4%, 15 and 4 to 14%. 27 As hypothermia is not supposed to increase neonatal seizures, the long and frequent video EEG recordings and the continuous video EEG monitoring considered in our methodology are a likely explanation. Nevertheless, the presence of neonatal seizures per se does not have an additional effect on the development of epilepsy, as it also happens due to other aspects of neurodevelopmental outcome.…”

Section: Discussionmentioning

confidence: 95%

Epilepsy Outcome in Cooled Hypoxic–Ischemic Encephalopathic Newborns

Marchiò¹,

Podestà²,

Briatore³

et al. 2018

J Pediatr Epilepsy

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Epilepsy is a frequent consequence of neonatal hypoxic–ischemic encephalopathy. It is not yet known if the introduction of therapeutic hypothermia modifies the rate and the characteristics of epilepsy. We report on 59 infants who suffered from hypoxic–ischemic encephalopathy and underwent therapeutic hypothermia. Birth, physiological and biochemical data, frequent electroencephalography (EEG) recordings or continuous EEG monitoring, and magnetic resonance imaging (MRI) were documented in the neonatal period. Prechtl's General Movements evaluation was performed and the Griffiths Scales of Mental Development were applied at 3 and 24 months of age, respectively. Children were followed up for at least 3 years (mean 5 ± 1.6 years). Six children (10%) developed epilepsy. All of them had a severe hypoxic–ischemic encephalopathy and were neurologically impaired at 2 years of age. Furthermore, all of them had a severe pattern of MRI injury and poor neonatal EEG backgrounds. Four of them suffered from neonatal status epilepticus. Four out of six showed a similar epileptic pattern: their epilepsy started early; it was drug resistant; it required an aggressive polytherapy; and it showed a spontaneous improvement after 2 years. The rate of epilepsy in our cooled infants was similar to those reported in other studies on noncooled ones. Only severe hypoxic–ischemic encephalopathy predisposed the cooled infants toward epilepsy. Neonatal status epilepticus and persisting poor EEG backgrounds were predictive of the development of epilepsy in our sample.

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“…In 2005 a national cooling register for cases with hypothermia was introduced in Switzerland [20, 21, 74–77]. According to this registry the following number of neonates were treated: 2005–2010: n = 150 (mean 15 annually), 2011–2012: 121 cool and uncool (mean 60 annually).…”

Section: Discussionmentioning

confidence: 99%

Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015

et al. 2017

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BackgroundThe ICD-10 categories of the diagnosis “perinatal asphyxia” are defined by clinical signs and a 1-minute Apgar score value. However, the modern conception is more complex and considers metabolic values related to the clinical state. A lack of consistency between the former clinical and the latter encoded diagnosis poses questions over the validity of the data. Our aim was to establish a refined classification which is able to distinctly separate cases according to clinical criteria and financial resource consumption. The hypothesis of the study is that outdated ICD-10 definitions result in differences between the encoded diagnosis asphyxia and the medical diagnosis referring to the clinical context.MethodsRoutinely collected health data (encoding and financial data) of the University Hospital of Bern were used. The study population was chosen by selected ICD codes, the encoded and the clinical diagnosis were analyzed and each case was reevaluated. The new method categorizes the diagnoses of perinatal asphyxia into the following groups: mild, moderate and severe asphyxia, metabolic acidosis and normal clinical findings. The differences of total costs per case were determined by using one-way analysis of variance.ResultsThe study population included 622 cases (P20 “intrauterine hypoxia” 399, P21 “birth asphyxia” 233). By applying the new method, the diagnosis asphyxia could be ruled out with a high probability in 47% of cases and the variance of case related costs (one-way ANOVA: F (5, 616) = 55.84, p < 0.001, multiple R-squared = 0.312, p < 0.001) could be best explained. The classification of the severity of asphyxia could clearly be linked to the complexity of cases.ConclusionThe refined coding method provides clearly defined diagnoses groups and has the strongest effect on the distribution of costs. It improves the diagnosis accuracy of perinatal asphyxia concerning clinical practice, research and reimbursement.

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The impact of a register on the management of neonatal cooling in Switzerland

Cited by 21 publications

References 24 publications

Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Epilepsy Outcome in Cooled Hypoxic–Ischemic Encephalopathic Newborns

Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015

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