Management of Hypothermia for Perinatal Asphyxia in Austria – a Survey of Current Practice Standards

Abstract

Background: Therapeutic hypothermia (HT) has been shown to reduce the risk of death or disability and increase the rate of survival free of ­disability at 18–24 months of age in hypoxic-ischemic encephalopathy (HIE).

Objectives: The aim of this study was to take a national survey which (a) evaluated the practice of therapeutic HT for perinatal asphyxia in Austria, (b) evaluated the current clinical management of neonatal HIE and (c) evaluated the need for a national perinatal asphyxia and HT registry.

Methods: In January 2013, a questionnaire was sent out to the clinical heads of all neonatal level-II and level-III units in Austria.

Results: We received replies from all 30 level II and level III units in Austria (response rate 100%). 19 units (63%) answered that they applied HT, 11 units (37%) said they transferred patients for cooling to other units, 3 of those 11 units (27%) said they applied cooling during transport. 25 units (83%) felt the necessity to establish a national registry.

Conclusion: The results of this survey show that there is already a high implementation of therapeutic HT in Austria, but there remains a need for information, awareness and training. Problem areas tend to be in the transport of asphyxiated neonates, brain monitoring during cooling and follow-up of affected patients. We believe, that the establishment of national guidelines and a national register could increase awareness for the importance of therapeutic HT in neonatal HIE, thus improve the Austrian management of those infants.

Zusammenfassung

Hintergrund: Es hat sich gezeigt, dass therapeutische Hypothermie (HT) bei hypoxisch-ischämischer Enzephalopathie (HIE) das Risiko von Tod oder Beeinträchtigung reduziert und die Überlebensrate ohne Beeinträchtigung im Alter von 18 bis 24 Monaten gebessert hat.

Ziel: Ziel dieser Studie war es, eine nationale Befragung durchzuführen um (a) die Umsetzung von therapeutischer HT bei perinataler HIE in Österreich zu untersuchen, (b) den aktuellen Standard beim Management von neonataler HIE zu befragen und um (c) das Interesse nach einem nationalen perinatalen Asphyxie und HT Register festzustellen.

Methoden: Im Jänner 2013 wurde ein Fragebogen an die Vorstände aller neonataler Level-II and Level-III Einheiten in Österreich ausgeschickt.

Resultate: Wir erhielten Antworten von allen befragten 30 Level-II and Level-III Einheiten. Neunzehn Einheiten (63%) antworteten, dass sie HT anwenden würden, 11 Einheiten (37%) sagten, sie würden Patienten zum Zweck der Kühlung an andere Abteilungen transferieren, 3 dieser 11 Einheiten (27%) würden auch während des Transports kühlen. Fünfundzwanzig Abteilungen (83%) hielten die Etablierung eines nationalen Registers für notwendig.

Konklusion: Die Ergebnisse dieser Befragung zeigen, dass therapeutische HT in Österreich weit etabliert ist, aber dass weiterhin ein Bedarf an Information und Training vorhanden ist. Heikle Themen bleiben nach wie vor Kühlung am Transport, Monitoring der Hirnfunktion während Kühlung sowie eine konsequente Nachuntersuchung der betroffenen Patienten. Die Etablierung eines nationalen Registers könnte das Österreichische Management von Neugeborenen mit HIE und die Durchführung der therapeutischen HT weiterhin optimieren.

Key words

asphyxia - cooling - hypothermia - hypoxic-ischemic ­encephalopathy

Schlüsselwörter

Asphyxie - Kühlung - Hypothermie - hypoxisch-ischämische Enzephalopathie

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