Objective Therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes. Design Retrospective cohort study using National Neonatal Research Database and propensity score-matching. Setting UK neonatal units. Patients Infants ≥36 weeks gestational age with moderate or severe HIE admitted 2011–2016. Interventions Birth in non-CC compared with CC. Main outcome measures Primary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer. Results 5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth. Conclusions Almost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration. Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data were extracted and supplied by the NDAU and are available from the corresponding author on reasonable request and with permission of the study team and NDAU.

中文翻译：

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有和没有主动低温治疗中心的新生儿缺氧缺血性脑病的结果：全国倾向评分匹配分析

目的 新生儿缺氧缺血性脑病 (HIE) 的治疗性低温 (TH) 主要在三级冷却中心 (CCs) 进行，可降低死亡率和神经功能障碍。目前尚不清楚在非冷却中心 (non-CC) 分娩，没有活跃的 TH，是否会影响短期结果。使用国家新生儿研究数据库和倾向评分匹配设计回顾性队列研究。设置英国新生儿单位。2011-2016 年入院的中度或重度 HIE 患者≥36 周胎龄的婴儿。干预措施 与 CC 相比，非 CC 出生。主要结果测量 主要结果是出院后未记录癫痫发作的存活率。次要结果是在转移后到达 CC 时记录的癫痫发作、死亡率和体温。结果共纳入 5059 名婴儿，其中 2364 名（46.7%）出生于非 CCs。CC 出生与无癫痫发作的生存率提高相关（35.1% 对 31.8%；OR 1.15，95% CI 1.02 至 1.31；p=0.02），癫痫发作较少（60.7% 对 64.6%；OR 0.84，95% CI 0.75 至0.95, p=0.007) 和相似的死亡率 (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) 与非 CC 出生相比。来自 2 级中心的匹配婴儿仅具有相似的结果，与非 CCs 相比，CCs 的出生与更高的无癫痫发作存活率相关。从非 CC 转移到 CC (n=2027) 后，1362 名 (67.1%) 婴儿到达记录的最佳治疗温度，但其中只有 259 名 (12.7%) 在出生后 6 小时内到达。结论 几乎一半的英国 HIE 婴儿出生在非 CC 环境中，这与亚低温治疗和无癫痫发作生存率降低有关。在向上转移之前在非 CC 医院提供活动 TH 值得考虑。可根据合理要求提供数据。所有与研究相关的数据都包含在文章中或作为补充信息上传。所有数据均由 NDAU 提取和提供，经研究团队和 NDAU 许可，可在合理要求下从相应作者处获得。