BMJ Paediatrics Open (Oct 2022)
Therapeutic hypothermia for neonatal encephalopathy with sepsis: a retrospective cohort study
- Kei Lui,
- Victor Samuel Rajadurai,
- Malcolm Battin,
- lex Doyle,
- Leah Hickey,
- Srinivas Bolisetty,
- Peter Schmidt,
- Andy Gill,
- Jane Pillow,
- Jacqueline Stack,
- Pita Birch,
- Dan Casalaz,
- Jim Holberton,
- Alice Stewart,
- Lucy Cooke,
- Lyn Downe,
- Michael Stewart,
- Andrew Berry,
- Rod Hunt,
- Tony De Paoli,
- Mary Paradisis,
- Pieter Koorts,
- Carl Kuschel,
- Andrew Numa,
- Hazel Carlisle,
- Nadia Badawi,
- Guan Koh,
- Jonathan Davis,
- Melissa Luig,
- Chad Andersen,
- Brian Darlow,
- Liza Edmonds,
- Mariam Buksh,
- Georgina Chambers,
- Clare Collins,
- David Barker,
- Denise Harrison,
- Steven Resnick,
- Jutta van den Boom,
- Peter Morris,
- Rebecca Thomas,
- Mary Sharp,
- Naomi Spotswood,
- M Battin,
- Scott Morris,
- Nicola Austin,
- Michael Stark,
- Anjali Dhawan,
- Larissa Korostenski,
- Karen Nothdurft,
- Mark Greenhalgh,
- John Craven,
- Himanshu Popat,
- Bevan Headley,
- Barbara Hammond,
- Kristina Sibbin,
- Tara M Crawford,
- Guy Bloomfield,
- Callum Gately,
- Natalie Merida
Affiliations
- Kei Lui
- 2 Australia and New Zealand Neonatal Network, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Victor Samuel Rajadurai
- 1 Department of Neonatology, KK Women`s and Children`s Hospital, Singapore
- Malcolm Battin
- 7 Department of Neonatology, Auckland District Health Board, Auckland, New Zealand
- lex Doyle
- Leah Hickey
- Srinivas Bolisetty
- Peter Schmidt
- Andy Gill
- 2 School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Jane Pillow
- Jacqueline Stack
- Pita Birch
- Dan Casalaz
- Jim Holberton
- Alice Stewart
- Lucy Cooke
- Lyn Downe
- Michael Stewart
- 1 Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children`s Hospital Melbourne, Parkville, Victoria, Australia
- Andrew Berry
- Rod Hunt
- Tony De Paoli
- Mary Paradisis
- Pieter Koorts
- 8 Grantley Stable Neonatal Unit, Royal Brisbane and Women`s Hospital, Herston, Queensland, Australia
- Carl Kuschel
- Andrew Numa
- Hazel Carlisle
- Nadia Badawi
- 3 Cerebral Palsy Alliance, The University of Sydney, Sydney, New South Wales, Australia
- Guan Koh
- Jonathan Davis
- Melissa Luig
- Westmead Department of Neonatology, Westmead Hospital, Westmead, New South Wales, Australia
- Chad Andersen
- 1 Neonatal Medicine, Women`s and Children`s Hospital Adelaide, North Adelaide, South Australia, Australia
- Brian Darlow
- Liza Edmonds
- 5 Division of Health Sciences, Kōhatu Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
- Mariam Buksh
- Georgina Chambers
- Clare Collins
- David Barker
- Denise Harrison
- Steven Resnick
- Jutta van den Boom
- Peter Morris
- Rebecca Thomas
- Biomedical Science, Swansea University, Swansea, Wales, UK
- Mary Sharp
- 2 School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Naomi Spotswood
- M Battin
- Scott Morris
- Nicola Austin
- Michael Stark
- Neonatal Medicine, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
- Anjali Dhawan
- Larissa Korostenski
- Karen Nothdurft
- Mark Greenhalgh
- John Craven
- Himanshu Popat
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney Medical School, Sydney, New South Wales, Australia
- Bevan Headley
- Barbara Hammond
- Kristina Sibbin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
- Tara M Crawford
- Neonatal Medicine, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
- Guy Bloomfield
- Callum Gately
- Natalie Merida
- DOI
- https://doi.org/10.1136/bmjpo-2022-001420
- Journal volume & issue
-
Vol. 6,
no. 1
Abstract
Objective Neonatal encephalopathy remains a major cause of infant mortality and neurodevelopmental impairment. Infection may exacerbate brain injury and mitigate the effect of therapeutic hypothermia (TH). Additionally, infants with sepsis treated with TH may be at increased risk of adverse effects. This study aimed to review the clinical characteristics and outcomes for infants with sepsis treated with TH.Design and setting Retrospective cohort study of infants treated with TH within Australia and New Zealand.Patients 1522 infants treated with TH, including 38 with culture-positive sepsis from 2014 to 2018.Intervention Anonymised retrospective review of data from Australian and New Zealand Neonatal Network. Infants with culture-positive sepsis within 48 hours were compared with those without sepsis.Main outcome measures Key outcomes include in-hospital mortality, intensive care support requirements and length of stay.Results Overall the rate of mortality was similar between the groups (13% vs 13%). Infants with sepsis received a higher rate of mechanical ventilation (89% vs 70%, p=0.01), high-frequency oscillatory ventilation (32% vs 13%, p=0.003) and inhaled nitric oxide for persistent pulmonary hypertension (38% vs 16%, p<0.001). Additionally, the sepsis group had a longer length of stay (20 vs 11 days, p<0.001).Conclusion Infants with sepsis treated with TH required significantly more respiratory support and had a longer length of stay. Although this may suggest a more severe illness the rate of mortality was similar. Further research is warranted to review the neurodevelopmental outcomes for these infants.
