Hypothermia therapy for neonatal hypoxic ischemic encephalopathy in the state of California.
Hypothermia therapy for neonatal hypoxic ischemic encephalopathy in the state of California.
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DOI：
10.1016/j.jpeds.2014.04.052
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发表时间：
2014-08
影响因子：
5.1
通讯作者：
Lee, Henry C.
中科院分区：
文献类型：
--
作者：
Kracer, Bernardo;Hintz, Susan R.;Van Meurs, Krisa P.;Lee, Henry C.
在以人群为基础的队列中，对新生儿缺氧缺血性脑病实施低温治疗。使用加州围产期质量护理协作和加州围产期运输系统链接的2010-2012年数据集；妊娠bb0 /=至36周伴有缺氧缺血性脑病的婴儿被归类为接受低温或体温正常。比较社会人口统计学和临床因素，并使用多变量logistic回归来确定与低温治疗相关的因素。2010年报告的脑病病例为238例，2011年为280例，2012年为311例。在整个研究期间，低温疗法在新生儿缺氧缺血性脑病中的应用从59%增加到73%，主要发生在轻度或中度脑病的新生儿中。共有36个中心提供低温治疗，照顾94%的婴儿，剩下的6%由其他25个中心中的一个照顾。在提供低温治疗的中心中，12个中心在3年的研究期间对超过20名患者进行了低温治疗，24个中心对低于20名接受低温治疗的患者进行了治疗。住院死亡率为13%，主要与脑病的严重程度有关。我们的研究结果强调了探索实践地点差异和开发质量改进干预措施的机会，以确保对患有缺氧缺血性脑病的足月婴儿进行一致的循证护理，并对符合条件的新生儿适当应用低温疗法。
To characterize the implementation of hypothermia for neonatal hypoxic ischemic encephalopathy in a population-based cohort. Using the California Perinatal Quality Care Collaborative and California Perinatal Transport System linked 2010–2012 datasets; infants >/= to 36 weeks gestation with hypoxic ischemic encephalopathy were categorized as receiving hypothermia or normothermia. Socio-demographic and clinical factors were compared and multivariable logistic regression was used to determine factors associated with hypothermia therapy. There were 238 reported encephalopathy cases in 2010, 280 in 2011 and 311 in 2012. Hypothermia therapy use in newborns with hypoxic ischemic encephalopathy increased from 59% to 73% across the study period, mainly occurring in newborns with mild or moderate encephalopathy. A total of 36 centers provided hypothermia and cared for 94% of infants, the remaining 6% being cared for at one of 25 other centers. Of the centers providing hypothermia, 12 centers performed hypothermia therapy to over 20 patients during the three-year study period, and 24 centers cared for < 20 patients receiving hypothermia. In-hospital mortality was 13%, primarily associated with the severity of encephalopathy. Our findings highlight an opportunity to explore practice site variation and to develop quality improvement interventions to assure consistent evidence-based care of term infants with hypoxic ischemic encephalopathy and appropriate application of hypothermia therapy for eligible newborns.
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