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Therapeutic Hypothermia after Perinatal Hypoxic Ischaemic Encephalopathy – Is it the standard of care in the UK?

Presented at the Neonatal Society 2010 Spring Meeting.

Tooley J, Gupta S, Ludlam C

St Michael’s Neonatal Unit, Bristol, UK

Background and Aim: Multicentre studies have confirmed that therapeutic hypothermia (HT) is effective at reducing poor outcome after perinatal hypoxic ischaemic injury. Some units (that were part of the UK TOBY study group) have been offering this treatment since the end of recruitment in 2006, however most units in the UK were awaiting publication of the TOBY study (1) before accepting it as the “standard of care”. This survey was conducted after publication to determine whether cooling is now deemed as “standard care” and universally practiced.

Methods: 178 (UK) hospitals were contacted by telephone (during Nov 09) to complete a structured questionnaire. Data from 166 hospitals was collected (53 level three, 82 level two and 31 level one units).

Results: Therapeutic HT was stated to be the standard of care in 149/166 (90%) hospitals. They either offered cooling themselves (44/149 (30%)) or referred elsewhere for cooling (105/149 (70%)). Only 17/166 (10%) hospitals did not offer cooling at all. Two were awaiting equipment (on order), 5 were awaiting an imminent network decision and 10 gave no reason. These 17 hospitals came from 7 separate neonatal networks. 2 networks did not offer HT (within network) at all. Regarding the provision of equipment: 91% of level 3 units had a CFM available (vs 43% (level 2) and 14% (level 1)). 73% of level 3 units had a cooling machine (vs 10% level 2 and one level 1 unit). Each level 3 centre with cooling equipment managed the whole cooling episode, whereas the majority of level 1,2 centres used their equipment to initiate cooling prior to transfer elsewhere. 82% of centres regularly submitted data to the TOBY register. There are notable derogations from published cooling protocols (5 centres had cooled babies <36 weeks, 4 centres had commenced cooling after 6hrs of age and only 66% used CFM to determine eligibility).

Conclusion: It now appears that therapeutic HT is the standard of care, with over 90% of hospitals either running a cooling programme or referring to a cooling centre. The vast majority of cooling takes place within level 3 centres. Only 10 hospitals out of 166 did not have plans to develop a referral pathway for therapeutic HT.

References
1. Azzopardi et al NEJM 2009;361:1349-1358

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