Abstract
Objective To determine the rate of therapeutic hypothermia (TH) use, current practices, and
long-term follow-up.
Study Design Prospective cross-sectional national survey with 19 questions related to the assessment
of hypoxic–ischemic encephalopathy (HIE) and TH practices. An online questionnaire
was made available to health care professionals working in neonatal care in Brazil.
Results A total of 1,092 professionals replied, of which 681 (62%) reported using TH in their
units. Of these, 624 (92%) provided TH practices details: 136 (20%) did not use any
neurologic score or amplitude-integrated electroencephalogram (aEEG) to assess encephalopathy
and 81(13%) did not answer this question. Any specific training for encephalopathy
assessment was provided to only 81/407 (19%) professionals. Infants with mild HIE
are cooled according to 184 (29%) of the respondents. Significant variations in practice
were noticed concerning time of initiation and cooling methods, site of temperature
measurements and monitoring, and access to aEEG, electroencephalogram (EEG), and neurology
consultation. Only 19% could perform a brain magnetic resonance imaging (MRI), and
31% reported having a well-established follow-up program for these infants.
Conclusion TH has been implemented in Brazil but with significant heterogeneity for most aspects
of hypothermia practices, which may affect safety or efficacy of the therapy. A step
forward toward quality improvement is important.
Keywords
therapeutic hypothermia - cooling survey - neonatal encephalopathy - cooling in middle-income
countries
