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Am J Perinatol 2019; 36(11): 1150-1156
DOI: 10.1055/s-0038-1676052
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Therapeutic Hypothermia in Brazil: A MultiProfessional National Survey

G. F. Variane
1   Neonatal Division, Department of Pediatrics, Irmandade da Sant Casa de Misericordia de Sao Paulo, Brazil
2   Neonatal Division, Grupo Santa Joana, Sao Paulo, Brazil
,
L. M. Cunha
3   Neonatal Division, Hospital NIPO Brasileiro, Sao Paulo, Brazil
,
P. Pinto
4   Department of Pediatrics, Universidade de Vassouras, Rio de Janeiro, Brazil
,
P. Brandao
5   Department of Neonatology, Universidade Federal de Juiz de Fora, Minas Gerais, Brazil
,
R. S. Mascaretti
6   Department of Pediatrics, Neonatal Division, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
,
Mauricio Magalhães
1   Neonatal Division, Department of Pediatrics, Irmandade da Sant Casa de Misericordia de Sao Paulo, Brazil
,
Guilherme M. Sant'Anna
7   Department of Pediatrics, Neonatal Division, McGill University Health Center, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

23 August 2018

14 October 2018

Publication Date:
15 December 2018 (online)

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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

Supplementary Material

 

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