Introduction Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of neonatal morbidity and mortality. Therapeutic hypothermia (TH) is an effective neuroprotective treatment. In the U.K NICE endorsed selected TH use in 5/2010. Access to treatment is increasing. Our institution is a tertiary neonatal unit serving South-East London perinatal network. We designed and implemented a TH program with established clinical governance procedures and a rolling training program followed by the treatment of the first patient in 8/2009.
Aim To present our experience in implementation of our TH program.
Methods Review of clinical records, aEEG, EEG and MRI of the infants treated with TH from 8/2009–3/2012.
Results 44 infants with moderate or severe HIE were treated. Mean GA:40 weeks (36–42 weeks). 61% outborn (N=27) 10/27 from outside SE-London. Treatment commenced at median age:2.5h for inborns. Outborns commenced passive cooling. On admission 30% of the outborns had rectal temperature < 30oC 48% of patients were treated for seizures before TH, 16%. During treatment 1 infant developed arrhythmia (PEA) after phenytoin. One infant required extended TH for seizures. 77% survived to discharge.
93% had brainMRI performed.
Conclusions Successful introduction of a TH program requires an on-going education program and established clinical governance procedures. Access toTH and transport procedures should be further improved. TH should ideally be provided in centres equipped to provide neurocritical intensive care able to address the complex medical needs of patients and families. There is urgent need to refine current TH protocols and encourage clinical trials of additional neuroprotective treatments.