Abstract
AimThe objective of this study was to describe the French practice of hypothermia treatment (HT) in full-term newborns with hypoxic-ischemic encephalopathy (HIE) and to analyze the deviations from the guidelines of the French Society of Neonatology.Materials and MethodsFrom May 2010 to March 2012 we recorded all cases of HIE treated by HT in a French national database. The population was divided into three groups, "optimal HT" (OHT), “late HT” (LHT) and “non-indicated” HT (NIHT), according to the guidelines.ResultsOf the 311 newborns registered in the database and having HT, 65% were classified in the OHT group, 22% and 13% in the LHT and NIHT groups respectively. The severity of asphyxia and HIE were comparable between newborns with OHT and LHT, apart from EEG. HT was initiated at a mean time of 12 hours of life in the LHT group. An acute obstetrical event was more likely to be identified among newborns with LHT (46%), compared to OHT (34%) and NIHT (22%). There was a gradation in the rate of complications from the NIHT group (29%) to the LHT (38%) group and the OHT group (52%). Despite an insignificant difference in the rates of death or abnormal neurological examination at discharge, nearly 60% of newborns in the OHT group had an MRI showing abnormalities, compared to 44% and 49% in the LHT and NIHT groups respectively.ConclusionThe conduct of the HT for HIE newborns is not consistent with French guidelines for 35% of newborns, 22% being explained by an excessive delay in the start of HT, 13% by the lack of adherence to the clinical indications. This first report illustrates the difficulties in implementing guidelines for HT and should argue for an optimization of perinatal care for HIE.
Highlights
The incidence of hypoxic ischemic encephalopathy (HIE) in newborns is currently imprecise with numbers ranging from 1 to 8 per 1000 live births worldwide [1,2]
The aim of this study was to describe the practice in France for full-term newborns with HIE treated by hypothermia treatment (HT), and to analyze deviations from the Society of Neonatology (SFN) guidelines and the reasons for these
Information regarding the intrapartum context associated with HIE was missing in 35% (n = 108) of cases
Summary
The incidence of hypoxic ischemic encephalopathy (HIE) in newborns is currently imprecise with numbers ranging from 1 to 8 per 1000 live births worldwide [1,2]. The method of identifying cases, the definition of HIE and the source study population have an impact on the reported incidence [3,4]. In France, apart from a study by Pierrat et al in the Nord Pas de Calais region, where an incidence of 0.86 per 1000 was found, little precise epidemiological data on HIE is available [5]. The prognosis is severe and mortality can reach 20 to 40% of cases. The rate of adverse outcomes (death, cerebral palsy, severe cognitive deficit) reaches 30 to 50% in cases with Sarnat stage II HIE and 100% for stage III [6,7,8]. Some studies report a 5–6 increased risk of epilepsy [10,11]
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