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  • Quality Improvement Article
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Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices

Journal of Perinatology (2024)Cite this article

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Abstract

Background

Infants at risk for hypoxic ischemic encephalopathy (HIE) require a time sensitive evaluation and decision-making regarding treatment with therapeutic hypothermia (TH). Prior to this project, there was no standardized approach to evaluating these infants locally.

Methods

Included infants were “at risk for HIE,” defined as meeting the “patient characteristics” and “biochemical criteria” per the institutional HIE pathway. Our primary outcome was documentation of an HIE therapeutic hypothermia evaluation (HIETHE) within the first six hours of life which included: (1) recognition of at-risk status, (2) an encephalopathy exam, and (3) a decision regarding TH. Plan-Do-Study-Act cycles included novel clinical decision support.

Results

From October 2020 to May 2023, among infants at-risk for HIE, the average percentage with an HIETHE documented improved from 47% to 82%.

Conclusions

We standardized the approach to infants at risk for HIE and improved the presence of a complete and timely evaluation regarding TH eligibility.

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Fig. 1: Driver diagram with change ideas.
Fig. 2: High-technology clinical decision support and documentation tool.
Fig. 3: Cord blood gas column.
Fig. 4: Statistical process control chart of the primary outcome metric.

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Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Patrick J. Peebles

  2. Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Lori Christ, John Flibotte & Leah H. Carr

  3. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lori Christ, John Flibotte & Leah H. Carr

  4. Division of Neonatology, Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA, USA

    Liandra Presser

  5. Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Leah H. Carr

Authors
  1. Patrick J. Peebles
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  2. Lori Christ
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  3. John Flibotte
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  4. Liandra Presser
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  5. Leah H. Carr
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Contributions

Dr PJ. Peebles conceptualized and designed the study, collected the data, performed the data analysis and interpretation of data, and drafted the initial manuscript. Dr LH. Carr conceptualized and designed the study, built the clinical decision support tools in the electronic health record, participated in the interpretation of data, and critically reviewed and revised the manuscript. Dr. LP collected the data, performed the data analysis and interpretation of data, and critically reviewed and revised the manuscript. Drs. LC and JF conceptualized and designed the study, participated in the interpretation of data, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Patrick J. Peebles.

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Competing interests

Dr. Flibotte has received advisory board honoraria from Janssen Pharmaceuticals and Momenta Pharmaceuticals. The submitted work is unrelated to these activities. Dr. Carr is a partial owner of 2minutemedicine.com, a medical education and news website. The submitted work is unrelated to this company. The other authors have no relevant conflicts to disclose.

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Peebles, P.J., Christ, L., Flibotte, J. et al. Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01916-4

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  • DOI: https://doi.org/10.1038/s41372-024-01916-4

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