Timing of initiation of therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy born at a high-volume urban safety net hospital

Background

Ethnic and racial disparities in neonatal outcomes have been well-documented, including higher risk of hypoxic-ischemic encephalopathy (HIE). Therapeutic hypothermia (TH) is the only approved treatment for infants with moderate to severe HIE and previous studies have shown mixed results regarding the impact of timing of initiation of TH on outcomes. These studies often include both inborn and outborn neonates and few minority patients.

Study design

This retrospective cohort study of exclusively inborn neonates from a high-volume, urban, safety net hospital (SNH) serving primarily racial/ethnic minority patients assessed the impact of timing of initiation of TH on short-term outcomes.

Results

There were 268 infants diagnosed with moderate or severe HIE from 2009 to 2023. After excluding patients for late cooling (n = 32), participation in a clinical trial (n = 41), and major comorbidities (n = 8), there were 187 patients for analysis. Similar to our neonatal population, this study cohort consisted of 94 % racial/ethnic minority patients. The average time to initiate TH was 4.4 ± 1.1 h of life (HOL) and 88 % of qualifying neonates received TH by 6 HOL. Those initiating TH at <4 HOL compared to 4–6 HOL were more likely to have severe HIE (p = 0.01). The adjusted OR for the primary outcome of in-hospital death was not associated with timing of initiation of TH [aOR = 0.75 (95 % CI 0.40–1.33); p = 0.33], nor were secondary outcomes of abnormal brain MRI or length of stay.

Conclusion

In a vulnerable population from a high-volume SNH, timing of initiation of TH was not associated with short-term outcomes.