Care of the newborn with perinatal asphyxia candidate for therapeutic hypothermia during the first six hours of life in Spain
Por:
Arnaez J, García-Alix A, Calvo S, Lubián-López S and Grupo de Trabajo ESP-EHI
Publicada:
1 oct 2018
Ahead of Print:
11 dic 2017
Categoría:
Pediatrics, perinatology and child health
Resumen:
Introduction: The process of care and assistance from birth to the starting of therapeutic hypothermia (TH) is crucial in order to improve its effectiveness and prevent the worsening of hypoxic-ischaemic injury.
Methods: A national cross-sectional study carried out in 2015 by use of a questionnaire sent to all level III units on the care of the newborn >= 35 weeks gestation within the first hours of life after a perinatal asphyxia event. According to clinical practice guidelines, the quality of care was compared between the hospitals that carried out or did not carry out TH, and according to the level of care.
Results: A total of 89/90 hospitals participated, of which 57/90 performed TH. They all used resuscitation protocols and turned off the radiant warmer after stabilisation. All of them performed glucose and blood gas analysis, monitored the central temperature, put the newborn on a diet, and performed at least two examinations for the diagnosis of hypoxic-ischaemic encephalopathy. Greater than one-third (35%) of hospitals did not have amplitude-integrated electroen-cephalogram, and 6/57 were TH-hospitals. The quality of care among hospitals with and without TH was similar, childbirth being better in those that performed TH, and those with a higher level of care. Level IIIc hospitals had higher scores than the others. The TH-hospitals mentioned not always having neonatologists with experience in neurological assessment and interpretation of amplitude-integrated electroencephalogram (25%), or in brain ultrasound (62%).
Conclusions: In response to the recommendations of the asphyxiated newborn, there is a proper national health care standard with differences according to the level of care and whether TH is offered. More amplitude-integrated electroencephalogram devices are necessary, as well as more neonatologists trained in the evaluations that will be require by the newborn with hypoxic-ischaemic encephalopathy. (C) 2017 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.
Filiaciones:
Arnaez J:
Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, España
Fundación NeNe, España
García-Alix A:
Fundación NeNe, España
Universitat de Barcelona, Barcelona, España
CIBER de Enfermedades Raras (CIBERER), U724, Madrid, España
Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Dèu, Barcelona, España
Calvo S:
Unidad de Investigación, Departamento de Estadística, Hospital Universitario de Burgos, Burgos, España
Lubián-López S:
Fundación NeNe, España
Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España
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