Holistic approach of the care of the infant with hypoxic-ischaemic encephalopathy in Spain
Por:
Arnaez J, Herranz N, García-Alix A, Grupo de Trabajo ESP-EHI and Grupo de Trabajo ESP-EHI. Unidades de Neonatología. Hospitales terciarios, Españ
Publicada:
1 may 2020
Ahead of Print:
2 ago 2019
Categoría:
Pediatrics, perinatology and child health
Resumen:
Introduction: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement.
Method: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5 sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan.
Results: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres.
Conclusions: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of Asociacion Espanola de Pediatria.
Filiaciones:
Arnaez J:
Unidad de Neonatología. Hospital Universitario de Burgos, Burgos, España. Fundación NeNe, España
Herranz N:
Departamento de Enfermería, Cultura del Cuidado. Unidad de Neonatología, Hospital Sant Joan de Déu, Barcelona. Fundación NeNe, España
García-Alix A:
Institut de Recerca Pediatrica Sant Joan de Dèu, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Universitat de Barcelona, Barcelona, España. CIBER de Enfermedades Raras (CIBERER), U724, Madrid. Fundación NeNe, España
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