Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis

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. UK study using national data investigate the effect of birth in or outside a recognised cooling centre on short term outcomes of babies >36 weeks with moderate to severe HIE. Birth in a cooling centre, is associated with improved survival to discharge without seizures, fewer seizures, and similar mortality.

Automated summary

This study in the UK found that almost half of infants with HIE were born in non-cooling centres, which led to suboptimal hypothermic treatment and reduced seizure-free survival. There is a need to consider providing active TH in non-CC hospitals prior to upward transfer.