EFFECTIVENESS OF THERAPEUTIC HYPOTHERMIA ON TRANSPORT WITHIN A LARGE GEOGRAPHICAL AREA
CPS ePoster Library. Redpath S. 06/25/15; 99151; 88
Dr. Stephanie Redpath
Dr. Stephanie Redpath
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Abstract
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The Canadian Paediatric Society (CPS) recommends Therapeutic Hypothermia (TH) be provided at level 3 NICUs. Initiation of TH within 6 h of life has been associated with benefit and is the current CPS standard of care. Given our large catchment area, the initiation of TH by conventional passive means often has to be considered at the referral hospital prior to or immediately upon arrival of the neonatal transport team (NNTT).
Objective: To determine the effectiveness of our approach to initiating TH within our region.
Design/Methods: Retrospective cohort study of all cases accepted for TH, between October 2009 and December 2013 at CHEO, a university-affiliated level 3 NICU and transported by our NNTT. All infants had moderate to severe encephalopathy and met NICHD criteria for TH.
Results: 60 infants (mean gestational age 39.1 week, birth weight 3.3 kg, arterial cord pH 6.9, Apgar scores 3 and 4 at 5 and 10 minutes) were included. The median time to initiation of TH was 2.5hrs and to target temperature 5.5hrs. No infant had temperatures <30C when cooled, 3 (5.4%) were <32C when cooled, all involved active cooling measures.
We subdivided the cohort according to the distance from CHEO: 'In town' (within 1 hour of base) or 'Out of town' (>/= 1hr). Comparing In town v Out of town; the median age of referral was 1.7 v. 0.9 hrs, median time to initiation of TH 1.6 v. 4 hrs, median age at NNTT arrival 2.8 v. 3.6hrs and the median birth to target temperature 5.4 v. 6.1hrs.
Conclusions: Meeting current CPS target for TH using passive cooling in a large catchment area is challenging. Preliminary studies using a servo-controlled device on transport indicate significant reductions in TH times in urban settings. The efficacy of novel technology in remote geographical areas remains to be determined.
The Canadian Paediatric Society (CPS) recommends Therapeutic Hypothermia (TH) be provided at level 3 NICUs. Initiation of TH within 6 h of life has been associated with benefit and is the current CPS standard of care. Given our large catchment area, the initiation of TH by conventional passive means often has to be considered at the referral hospital prior to or immediately upon arrival of the neonatal transport team (NNTT).
Objective: To determine the effectiveness of our approach to initiating TH within our region.
Design/Methods: Retrospective cohort study of all cases accepted for TH, between October 2009 and December 2013 at CHEO, a university-affiliated level 3 NICU and transported by our NNTT. All infants had moderate to severe encephalopathy and met NICHD criteria for TH.
Results: 60 infants (mean gestational age 39.1 week, birth weight 3.3 kg, arterial cord pH 6.9, Apgar scores 3 and 4 at 5 and 10 minutes) were included. The median time to initiation of TH was 2.5hrs and to target temperature 5.5hrs. No infant had temperatures <30C when cooled, 3 (5.4%) were <32C when cooled, all involved active cooling measures.
We subdivided the cohort according to the distance from CHEO: 'In town' (within 1 hour of base) or 'Out of town' (>/= 1hr). Comparing In town v Out of town; the median age of referral was 1.7 v. 0.9 hrs, median time to initiation of TH 1.6 v. 4 hrs, median age at NNTT arrival 2.8 v. 3.6hrs and the median birth to target temperature 5.4 v. 6.1hrs.
Conclusions: Meeting current CPS target for TH using passive cooling in a large catchment area is challenging. Preliminary studies using a servo-controlled device on transport indicate significant reductions in TH times in urban settings. The efficacy of novel technology in remote geographical areas remains to be determined.
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