Assessment of a hypothermia protocol implementation for hypoxic-ischemic encephalopathy in term newborns

Background. A whole-body hypothermia protocol for term infants with hypoxic-ischemic encephalopathy (HIE) was implemented in our network in May 2004. The main objective of this study was to assess the feasibility of the protocol. The impact on the outcome was also assessed. Methods. Monocentric retrospective study of all term infants admitted for HIE after the implementation of the protocol. The feasibility of the protocol was evaluated by its observance during the first 72 h. The neurodevelopmental outcome at 12 months of age of this population was compared with a historical control group. Results. Twenty-five children were included. The protocol was not correctly applied for 8 children. The target temperature (33-34 degrees C) was not reached for 3 infants. Four infants were admitted after 6 h of age. In 1 infant, HIE was not diagnosed at admission. In the :17 patients with a good protocol observance, rectal temperature fell to the target temperature on average at 6.4 h of age. The long-term follow-up rate was improved after the implementation of the protocol (100 % versus 92 % before protocol implementation). Death or neurodevelopmental disability occurred in 40 % during the protocol period versus 87 % before protocol implementation (p < 0.01). Conclusions. The main limiting factor for implementation of whole-body hypothermia in infants with HIE is admission delay. The follow-up and the rate of death or disability in infants with HIE improved after implementing the protocol. (C) 2010 Elsevier Masson SAS. All rights reserved.