Therapeutic hypothermia in severe hypoxic-ischemic encephalopathy: a cost-effectiveness analysis

Packer, Claire H.; Hersh, Alyssa R.; Sargent, James; Caughey, Aaron B.

doi:10.1080/14767058.2020.1733519

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…Besides the difference in the design of their study, other possible reasons for the differences in the outcome of TH between the present study and the HELIX study include the relatively smaller sample size, different diagnostic criteria used, and a much higher proportion (80%) of outborn neonates recruited in the HELIX study. Many studies from HICs reported better long-term neurodevelopmental outcomes and cost-effectiveness in survivors of moderate HIE following TH (20,21). In Malaysia, there is a need to carry out similar studies to confirm the benefits of TH on these high-risk neonates, including comparing the outcome of HIE neonates treated with P±CGP vs. SCD, like studies reported in other LMICs (11,22).…”

Section: Discussionmentioning

confidence: 97%

An Observational Study of Therapeutic Hypothermia and Factors Associated With Mortality in Late-Preterm and Term Neonates With Hypoxic-Ischemic Encephalopathy in a Middle-Income Country

Neoh²,

Chee³

2022

Front. Pediatr.

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ObjectivesTo investigate the types of therapeutic hypothermia (TH) used and risk factors associated with mortality in late-preterm and term neonates (LPTN, gestation of ≥35 weeks) with hypoxic-ischemic encephalopathy (HIE) in a middle-income country.DesignThis was an observational retrospective cohort study.SettingA total of 44 neonatal intensive care units (NICUs) in the Malaysian National Neonatal Registry participated in the study.PatientsAll LPTN without major malformations and diagnosed to have HIE were included.Main Outcome MeasuresNumber of in-hospital mortality, and types of TH used [no TH, TH using commercially available servo-controlled devices (SCDs), passive TH by exposing neonates to NICU’s air-conditioned ambient temperature with/without the use of cooled gel packs (P±CGPs)].ResultsOf a total of 2,761 HIE neonates, 66.3% received TH. All NICUs provided TH; 55.4% NICUs had SCDs, which was administered to 43.6% (248/569) of severe, 51.6% (636/1,232) of moderate, and 18.6% (179/960) of mild HIE neonates. P±CGPs was used on 26.9% of severe, 33.4% of moderate, and 21.1% of mild HIE neonates. There were 338 deaths. Multiple logistic regression analysis showed that 5-min Apgar scores <5 (aOR: 1.436; 95% CI: 1.019, 2.023), Cesarean section (aOR: 2.335; 95% CI: 1.700, 3.207), receiving no TH (aOR: 4.749; 95% CI: 3.201, 7.045), TH using P±CGPs (aOR: 1.553; 95% CI: 1.031, 2.338), NICUs admitted <50 HIE cases (aOR: 1.898; 95% CI: 1.225, 2.940), NICUs admitted 50-<100 HIE cases (aOR: 1.552; 95% CI: 1.065, 2.260), moderate HIE (aOR: 2.823; 95% CI: 1.495, 5.333), severe HIE (aOR: 34.925, 95% CI: 18.478, 66.012), Thompson scores of 7–13 (aOR: 1.776; 95% CI: 1.023,3.082), Thompson scores of ≥14 (aOR: 3.641; 95% CI: 2.000, 6.629), pneumothorax (aOR: 3.435; 95% CI: 1.996, 5.914), and foreigners (aOR: 1.646; 95% CI: 1.006, 2.692) were significant risk factors associated with mortality.ConclusionBoth SCD and P±CGP were used for TH. Moderate/severe HIE and receiving passive/no TH were among the risk factors associated with mortality.

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Section: Discussionmentioning

confidence: 97%

An Observational Study of Therapeutic Hypothermia and Factors Associated With Mortality in Late-Preterm and Term Neonates With Hypoxic-Ischemic Encephalopathy in a Middle-Income Country

Neoh²,

Chee³

2022

Front. Pediatr.

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“…TH is a cost-effective strategy in the management of neonates with moderate to severe HIE, however, components of its associated NNCC have not been fully studied. We previously reported the median (IQR) hospitalization cost per case among 19 NICUs participating in CHND for survivors was $58 552 ($32 476-$130 203) and for nonsurvivors was $29 760 ($16 897-$61 399) .…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic hypothermia (TH) is, to date, the most effective therapy to improve neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy (HIE) . Although TH is a cost-effective management strategy, practices and costs vary widely across centers, as reported previously …”

Section: Introductionmentioning

confidence: 98%

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

et al. 2023

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ImportanceIntercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.ObjectiveTo determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE.Design, Setting, and ParticipantsRetrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children’s hospitals participating in the Children’s Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022.ExposuresInfants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles.Main Outcomes and MeasuresThe main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared.ResultsAmong the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P &lt; .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P &lt; .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high– or medium–hospitalization cost centers and death or NDI. High– and medium–EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]). High– and medium–laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95% CI, 1.19-4.66]; medium vs low: OR, 1.93 [95% CI, 1.07-3.47]). High–antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95% CI, 1.51-9.18]; medium vs low: OR, 1.56 [95% CI, 0.71-3.42]).Conclusions and RelevanceHospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.

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“…However, there is a lack of reliable, sensitive, and specific criteria predicting neurological deterioration in NESHIE patients [ [19] , [20] , [21] ]. Environmental factors alone do not explain why some infants with NESHIE have unfavourable responses to therapeutic hypothermia (TH), the current standard of care, while other infants show significant improvement following TH [ 21 , 22 ]. Genetic and epigenetic mechanisms play an important role in the response to hypoxia [ [23] , [24] , [25] ], suggesting that a complex interplay between genetic and environmental factors may underlie NESHIE pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

The NESHIE and CP Genetics Resource (NCGR): A database of genes and variants reported in neonatal encephalopathy with suspected hypoxic ischemic encephalopathy (NESHIE) and consequential cerebral palsy (CP)

Holborn¹,

Ford²,

Turner³

et al. 2022

Genomics

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Therapeutic hypothermia in severe hypoxic-ischemic encephalopathy: a cost-effectiveness analysis

Cited by 9 publications

References 23 publications

An Observational Study of Therapeutic Hypothermia and Factors Associated With Mortality in Late-Preterm and Term Neonates With Hypoxic-Ischemic Encephalopathy in a Middle-Income Country

An Observational Study of Therapeutic Hypothermia and Factors Associated With Mortality in Late-Preterm and Term Neonates With Hypoxic-Ischemic Encephalopathy in a Middle-Income Country

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

The NESHIE and CP Genetics Resource (NCGR): A database of genes and variants reported in neonatal encephalopathy with suspected hypoxic ischemic encephalopathy (NESHIE) and consequential cerebral palsy (CP)

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