Abstract
Objective Therapeutic hypothermia (TH) is currently the only effective therapy available to
improve outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and has maximal
effect when initiated within 6 hours of birth. Neonates affected by HIE are commonly
born outside of cooling centers and transport is a barrier to timely initiation. In
this study, we sought to determine if the initiation of servo-controlled TH in transport
allowed neonates to reach target temperature earlier, without a significant delay
in the transfer process, for both local and long-distance transport.
Study Design In this single-center cohort study of neonates referred to a level IV neonatal intensive
care unit for TH, we determined the chronologic age at which target temperature was
reached for those cooled in transport. Short-term outcome measures were assessed,
including survival, incidence of electrographic seizures, discharge feeding method,
and length of hospitalization.
Results In a study population of 85 neonates, those receiving TH during transport (n = 23), achieved target temperature (33–34°C) 77 minutes sooner (230 ± 71 vs. 307 ± 79 minutes
of life (MOL); p < 0.001). Locally transported neonates (<15 miles) achieved target temperature 69 minutes
earlier (215 ± 48 vs. 284 ± 74 MOL; p < 0.01). TH during long-distance transports allowed neonates to reach target temperature
81 minutes sooner (213 ± 85 vs. 294 ± 79 MOL; p < 0.01). Infants who were cooled in transport discharged 4 days earlier (13.7 ± 8
vs. 17.8 ± 13 days; p = 0.18) and showed a significantly higher rate of oral feeding at discharge (95 vs.
71%; p = 0.03).
Conclusion For those starting TH in transport, time to target temperature was decreased. In
our cohort, cooling in transport was associated with improved short-term outcomes,
although additional studies are needed to correlate these findings with long-term
outcomes.
Key Points
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Therapeutic hypothermia started during transport allows shorter time to target temperature.
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Transfer was minimally delayed by starting cooling in transport.
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Cooling in transport was associated with increased rate of oral feeding at hospital
discharge.
Keywords
hypoxic-ischemic encephalopathy - neonatal transport - therapeutic hypothermia - birth
asphyxia - active cooling - transport cooling - birth depression
