Research Navigator MaineHealth Portland, Maine, United States
Background: In the Northern New England states of Maine, New Hampshire and Vermont, distances between community hospitals where neonates are delivered and the tertiary care center where they are treated with therapeutic hypothermia (TH) can be sizeable. Objective: We aimed to determine if birth in a community hospital (outborn) compared to birth in a tertiary care center (inborn) was associated with adverse short-term outcomes including death or severe gray matter injury on brain magnetic resonance imaging (MRI). Design/Methods: We created the Northern New England Regional Hypothermia Database (NERHD) with data contributions from Maine Medical Center, The University of Vermont Medical Center, and the Elliot Hospital. We performed manual chart review for all neonates treated with TH from 2009-2023. We compared place of birth (outborn vs. inborn) for the combined outcome of death or the presence of severe injury on brain MRI as determined by the Weeke scoring system (gray matter subscore >9.5). We performed logistic regression analysis to assess the association between inborn/outborn and death or gray matter injury using R(v.4.2.1). Results: Of 352 neonates treated with TH, 147 were inborn and 205 were outborn. In general, mothers of inborn neonates had a higher level of medical complexity, including gestational diabetes (14% vs 9%), preeclampsia/eclampsia (12% vs 8%), and chorioamnionitis (16% vs 4%). More inborn neonates were delivered at gestational age < 37 weeks (14% vs 10%) and by C-section (58% vs 48%). There were 8 (5%) inborn and 13 (6%) outborn neonates with the combined outcome of death or severe gray matter injury on MRI. There was no association between inborn/outborn and death or gray matter injury after controlling for severity of encephalopathy (p=0.205). The median time to initiation of TH was 2 hours (IQR 1, 3.4) for inborn neonates and 4 hours (IQR 3, 5) for outborn neonates (p < 0.001).
Conclusion(s): Inborn neonates have a higher level of medical complexity and a significantly shorter time to initiation of TH. There is however no relationship between place of birth (inborn vs. outborn) and short-term outcomes including death or severe gray matter injury on MRI. Slightly later initiation of TH was not associated with adverse short-term outcomes. This finding is reassuring and may alleviate some of the urgency surrounding decision making regarding the initiation of TH. Future research is needed to determine if longer term developmental outcomes are impacted by place of birth and/or the time to initiate TH.
