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Survey of sedation, respiratory support and parental contact practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy

Presented at the Neonatal Society 2018 Summer Meeting.

Jordan E1, Grant M1, Bhakthavalsala S1, Chakkarapani E2

1 Gloucestershire Royal Hospital, Gloucester, UK
2 Translational health sciences, University of Bristol, Bristol, UK

Background: Babies who underwent Therapeutic Hypothermia (TH) in the TOBY trial for Hypoxic Ischaemic Encephalopathy (HIE) routinely received full intensive care including mechanical ventilation, analgesia and sedation. Since TH became standard treatment, the practice of intensive care is unknown. Lack of parental contact during TH is reported to affect parent-infant bonding.2 Our survey aims to evaluate current sedation, respiratory support and parental contact practices for neonates undergoing TH for HIE in UK neonatal units.

Methods: We designed a questionnaire enquiring (1) whether parents are allowed to cuddle the babies during cooling or rewarming (2) whether babies are ventilated or commenced on CPAP (3) whether sedation and analgesia were routinely used and (4) what weaning strategies were used for ventilation and analgesia / sedation. An email was sent with an attached word document of the survey to neonatal network leads. We contacted the network again if there was no response in two weeks. Descriptive statistics are provided.

Results: Twenty-seven responses were received 27/57(47%). Of the 20 UK neonatal networks; a response was received from at least one unit from within14 of those networks. Only 4/27 (14%) routinely intubated regardless of respiratory status and 3 of those would not consider extubating during TH. 23/27 (85%) would consider CPAP as a form of respiratory support. 20/27 (74%) routinely use sedation, the remainder would do so dependent on patient distress. 22/27 (81%) would consider weaning sedation during TH. All units use morphine as their sedation drug of choice. With respect to parental contact, 26/27 (96%) units did not allow ‘cuddles’, citing risk of line/probe/tube displacement and temperature instability as their main concerns, followed by the severity of the clinical situation, patient distress, and staff capacity. Only one unit allow cuddles to encourage bonding and noted no adverse affects.

Conclusion: There is significant variation in the current practice of intensive care during therapeutic hypothermia compared to the TOBY trial. The vast majority of the units surveyed individualise respiratory support and sedation based on the infant’s clinical status. Most units were concerned about the safety of parental cuddles during cooling.

Corresponding author: ela.chakkarapani@bristol.ac.uk

1. Azzopardi D,et al. N Engl J Med 2009;361:1349-58.
2. Thyagarajan B et al. J Maternal Fetal Neonatal Med 2017;11:1-7.

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