PS-149 Initiation Of Therapeutic Hypothermia By Referring Hospitals During Neonatal Transport – Experience In Victoria, Australia

Abstract

<h3>Background</h3> Hypothermia is an effective treatment for moderate-severe hypoxic-ischaemic encephalopathy (HIE) in term newborns. Non-tertiary units (NTUs) may initiate controlled whole-body hypothermia to a target rectal temperature of 33–34<b>°</b>C in consultation with the Newborn Emergency Transport Service (NETS) by removing external heat sources prior to arrival of the NETS team. We aimed to evaluate temperature outcomes during neonatal transport when hypothermia was initiated by the referring NTU. <h3>Method</h3> We retrospectively audited NETS records of infants with HIE treated with hypothermia from September 2008–August 2012. Infants in whom hypothermia was initiated by the NTU were compared with those in whom the NETS team started cooling. <h3>Results</h3> Demographics of the 123 included infants were comparable between groups. Infants cooled by NTUs began cooling earlier (1.10 vs. 3.25 h after birth, p &lt; 0.01) and reached the target temperature (33–34^°C) sooner (3.35 vs. 4.54 h, p &lt; 0.01) than infants cooled by NETS. There was no difference in time of referral, stabilisation, or arrival at receiving hospital. There was a trend towards more infants cooled by NTUs achieving the target temperature (33–34^°C), OR 2.19 (0.96, 4.96). Infants cooled by NTUs were more likely to have temperatures &lt;33^°C, OR (95% CI) 5.39 (1.64, 22.83), but had fewer temperatures &gt;37^°C, OR (95% CI) 0.25 (0.07, 0.85). <h3>Conclusions</h3> Controlled whole body-hypothermia initiated by regional NTUs, with guidance from NETS, allows earlier initiation of cooling, and attains the target 33–34^oC sooner to optimise neuroprotection in newborns with HIE. Clinical practice should focus on avoiding temperatures &lt;33^°C and preventing hyperthermia.