ABSTRACT

Background

Management of hypoxic-ischaemic encephalopathy (HIE) by therapeutic hypothermia (TH) is a major challenge in low- and middle-income countries (LMIC) because of the limited resources. Clinicians in LMIC offer this intervention outside neonatal intensive care units (NICU). The effect of this practice on neurodevelopmental outcome is not well known.

Aim

To determine neurodevelopmental outcome in neonates with HIE managed with TH outside NICU settings.

Methods

: This was a retrospective descriptive study of neonates with HIE managed with TH and followed up for neurodevelopmental assessment at 12 and 18–24 months postnatal age. Patients were reviewed over a 24-month period. Outcome at 12 and 18–24 months was compared.

Results

Of 178 neonates with HIE attending the clinic, there was information on TH for 155 (87.1%), 113 of whom (72.9%) received TH. HIE was moderate in 88% and severe in 10%. Twenty-seven (23.9%) and 16 (14.1%) were assessed at one time-point at 12 or 18–24 months, respectively, 40 (35.3%) at both time-points, and 30 (26.6%) were not assessed. At 18–24 months, 32% had moderate-to-severe disability compared with 6% at 12 months, with the sensitivity and specificity of assessment at 12 months being 50% and 100%, respectively. The disability attrition rate at 18–24 months was 50%.

Conclusions

The relatively low prevalence of disability (32%) at 18–24 months suggests that use of TH in a Level 2 nursery is feasible and possibly beneficial. More studies are needed to confirm these findings

Abbreviations

aEEG: amplitude electroencephalogram; CP: cerebral palsy; GMDS: Griffiths mental developmental scales; GQ: general quotient; HIC: high-income countries; HIE: hypoxic-ischaemic encephalopathy; LMIC: low- and middle-income countries; LTFU: loss to follow-up; NICU: neonatal intensive care unit; TH: therapeutic hypothermia; TOBY: total body hypothermia.

中文翻译：

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在重症监护病房外的三级公立医院接受低温治疗的缺氧缺血性脑病新生儿的神经发育结局

摘要

背景

由于资源有限，通过低温治疗 (TH) 治疗缺氧缺血性脑病 (HIE) 是低收入和中等收入国家 (LMIC) 的一项重大挑战。LMIC 的临床医生在新生儿重症监护病房 (NICU) 之外提供这种干预。这种做法对神经发育结果的影响尚不清楚。

目标

确定在 NICU 环境外使用 TH 管理的 HIE 新生儿的神经发育结果。

方法

：这是一项对 HIE 新生儿进行 TH 管理的回顾性描述性研究，并在出生后 12 个月和 18-24 个月时进行神经发育评估。患者在 24 个月内接受审查。比较了 12 个月和 18-24 个月的结果。

结果

在就诊的 178 名 HIE 新生儿中，有 155 名 (87.1%) 的 TH 信息，其中 113 名 (72.9%) 接受了 TH。HIE 88% 为中度，10% 为重度。27 例 (23.9%) 和 16 例 (14.1%) 分别在 12 个月或 18-24 个月的一个时间点进行评估，40 例 (35.3%) 在两个时间点进行评估，30 例 (26.6%) 未评估. 在 18-24 个月时，32% 患有中度至重度残疾，而在 12 个月时为 6%，12 个月时评估的敏感性和特异性分别为 50% 和 100%。18-24 个月的残疾减员率为 50%。

结论

18-24 个月的残疾发生率相对较低（32%）表明在 2 级托儿所中使用 TH 是可行的并且可能是有益的。需要更多的研究来证实这些发现

缩写

aEEG：振幅脑电图；CP：脑瘫；GMDS：格里菲斯心理发展量表；GQ：一般商；HIC：高收入国家；HIE：缺氧缺血性脑病；LMIC：低收入和中等收入国家；LTFU：失访；NICU：新生儿重症监护室；TH：治疗性低温；托比：全身体温过低。