Pediatric Resident Physician Medical University of South Carolina College of Medicine Charleston, South Carolina, United States
Background: Therapeutic hypothermia (TH) increases the rate of survival and decreases the incidence of neurodevelopmental disability after hypoxic ischemic encephalopathy (HIE) in term neonates. TH protocols at many centers have gestational age criteria of >36 weeks GA. There are few reports that focus on TH in late preterm infants, instead including lower gestational ages (32-33 weeks), or publish their safety monitoring protocols. Inadequate monitoring of infants at higher risk for hypothermia complications and older cooling equipment with wide cooling blanket temperature swings may increase both adverse events and expected difficulty with tight control of core temperatures. In addition, few studies have reported longer term outcomes. At MUSC, we have included late preterm infants from 34 weeks GA in our TH studies since 1999, with the rationale that the primary increased risk is to coagulopathy, and we routinely systemically anticoagulate > 34 weeks GA neonates for ECMO without increased adverse events with careful monitoring. Objective: To perform a retrospective review of our late preterm infants with HIE undergoing hypothermia, comparing adverse events and neurodevelopmental outcomes with term cooled neonates and neonates 32-33 weeks who did not qualify for hypothermia at our institution. Design/Methods: This is a retrospective, IRB-exempt review of medical records. We will describe the in-hospital and neurodevelopmental outcomes of HIE infants 34-36 weeks GA treated with TH at MUSC from 2012-2022 and compare these results to the cooled term HIE group at MUSC and the 32-33 week preterm HIE infants who were not eligible for cooling, to assess for a clinically significant difference in complications and/or neurodevelopmental outcomes. Redcap will be used to record data variables, including hyper- and hypoglycemia, temperature variations, coagulation parameters, platelet and plasma replacement products, hypotension, and other adverse events, and neurodevelopmental follow-up testing available from our high-risk clinic. We plan to complete data collection and analysis by 3/2024.
