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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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.
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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