The impact of a register on the management of neonatal cooling in Switzerland. Issue 4 (April 2015) - Brotschi, Barbara
Abstract: Background: Therapeutic hypothermia following hypoxic ischaemic encephalopathy in term infants was introduced into Switzerland in 2005. Initial documentation of perinatal and resuscitation details was poor and neuromonitoring insufficient. In 2011, a National Asphyxia and Cooling Register was introduced. Aims: To compare management of cooled infants before and after introduction of the register concerning documentation, neuromonitoring, cooling methods and evaluation of temperature variability between cooling methods. Study design: Data of cooled infants before the register was in place (first time period: 2005–2010) and afterwards (second time period: 2011–2012) was collected with a case report form. Results: 150 infants were cooled during the first time period and 97 during the second time period. Most infants were cooled passively or passively with gel packs during both time periods (82% in 2005–2010 vs 70% in 2011–2012), however more infants were cooled actively during the second time period (18% versus 30%). Overall there was a significant reduction in temperature variability (p < 0.001) comparing the two time periods. A significantly higher proportion of temperature measurements within target temperature range (72% versus 77%, p < 0.001), fewer temperature measurements above (24% versus 7%, p < 0.001) and more temperatures below target range (4% versus 16%, p < 0.001) were recorded during the second time period. Neuromonitoring improved after introduction of the cooling register. Conclusion: Management of infants with HIE improved since introducing the register. Temperature variability was reduced, more temperature measurements in the target range and fewer temperature measurements above target range were observed. Neuromonitoring has improved, however imaging should be performed more often. Highlights: Clinical management of infants with hypoxic ischemic encephalopathy has improved since the introduction of a register. Comparing three different cooling methods, seem the best cooling method for keeping the temperature stable. However passive cooling with additional gel packs seems the best cooling method for keeping temperature within target range. Neuromonitoring has improved, but for counselling the parents appropriately MRI should be performed before discharge.