363 - Incidence of Outborn babies referred for Therapeutic Hypothermia in British Columbia who achieve target temperature during transport within 6 hours of life

Poster Number: 363
Publication Number: 363.132

Phanice M. Okara, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Bone N. Jeffrey, British Columbia Children's Hospital, Vancouver, BC, Canada; Michael Castaldo, BC Women's Hospital, Vancouver, BC, Canada; Pascal M. Lavoie, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Sandesh Shivananda, Ubc, Vancouver, BC, Canada; Naama Rozen, BC Women’s Hospital + Health Centre, Vancouver, BC, Canada

Background: Hypoxic-Ischemic Encephalopathy (HIE) carries high neurodevelopmental morbidity, with mortality in up to 20% in severe cases. After the primary insult, brain injury can continue to occur secondary to energy failure. Hypothermia to 33-34oC initiated within the first 6 hours has been shown to reduce the risk of moderate to severe disability or death by about 28 % as per NICHD study in 2005, and has become the standard of care in newborns with moderate to severe HIE.

Objective: The objectives of this study were to determine the proportion of outborn infants requiring therapeutic hypothermia for HIE, who achieved therapeutic hypothermia within 6 hours of life during transport and their outcomes

Design/Methods: Retrospective cross-sectional study. The Infant Transport Team (ITT) transports all infants in BC (~5.071 million population, with about 25% living in rural areas), covering a 944,735 km2 area with the furthest hospital being 1500km away from the main city of Vancouver. Study population included outborn infants admitted to BC Women’s Hospital NICU between 2015 and 2020, who required acute medical transport by ITT for therapeutic hypothermia. Main variables are listed in Table 1, plus brain MRI results, in-hospital death, discharged home and/or referral. Main outcome was the percentage of infants that achieved core body temperature of 33 to 34 degrees Celsius, within 6 hours of life.

Results: Of 147 babies, 131 had last temperatures censored at 6 hours of life with only 16.7% (21/131) who achieved therapeutic hypothermia within 6 hours of life. The median time to reach therapeutic hypothermia was 11.8 hours (95% CI 10.8, 16.4). Among the 130 babies who had MRI done between 3 and 5 days of age, 52 (40%) had evidence of HIE injury and 10.2% died.
 Conclusion(s): Among outborn infants with HIE requiring transport to a level 3 NICU in a large geographical area of Western Canada, only a minority achieved target therapeutic temperature within 6 hours of life, despite evidence of brain injury in most of these infants.  These data warrant improved measures to achieve therapeutic hypothermia during transport in BC.
Baseline characteristics of outborn babies in BC who required Therapeutic Hypothermia between 2015 and 2020
MRI results amongst outborn babies with HIE in BC referred for Therapeutic hypothermia