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Am J Perinatol 2022; 39(06): 633-639
DOI: 10.1055/s-0040-1718372
Original Article

Therapeutic Hypothermia in Transport Permits Earlier Treatment Regardless of Transfer Distance

Rachel L. Leon
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
2   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
,
Katherine E. Krause
3   Departments of Pediatrics and Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
,
Rebecca S. Sides
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
,
Mary Beth Koch
4   Riley Hospital for Children at IU Health, Indianapolis, Indiana
,
Michael S. Trautman
5   Indiana University Health Lifeline Transport Services, Indianapolis, Indiana
,
Ulrike Mietzsch
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
6   Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington
› Author Affiliations
Funding This project was funded by the Riley Children's Foundation.
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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

  • Therapeutic hypothermia started during transport allows shorter time to target temperature.

  • Transfer was minimally delayed by starting cooling in transport.

  • 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


Publication History

Received: 16 December 2019

Accepted: 28 August 2020

Article published online:
14 October 2020

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