Aggressive response in management and treatment of neonatal hypoxic-ischemic encephalopathy: Facilitating hypothermia therapy

Hypoxic-ischemic encephalopathy (HIE) is a negative birth outcome and common cause of neonatal mortality or significant chronic morbidity. The associated mortality rate is reportedly as high as 50 percent and an estimated 80 percent of survivors develop severe long-term neuro-developmental complications. Prompt recognition and treatment can effectively reduced HIE-associated neonatal mortality and morbidity. Hypothermia therapy, a cutting-edge treatment option, has been added to the arsenal for managing HIE. It is an effective treatment option if started within the first four to six hours after birth. The equipment cost, required monitoring, and level of skill needed limit the number of facilities providing hypothermia therapy. New York City Health and Hospitals Corporation (HHC), like many other hospitals in New York, are not equipped to provide this highly specialized form of treatment. Identified candidates are transferred to a recognized center equipped to provide such care. HHC is a public corporation that provides obstetrical and neonatal care to a diverse, multicultural, underserved population. Of the approximately 23,000 infants delivered annually at HHC's 11 hospitals, 24 percent are admitted to the Neonatal Intensive Care Units (NICUs). In 2009, HHC transferred 12 neonates for hypothermia therapy to a recognized treatment center. NICU providers have been provided with guidelines for recognizing candidates for hypothermia therapy and are encourage to promptly transfer identified candidates for therapy. To facilitate early recognition and transfer of infants meeting criteria for hypothermia treatment, HHC embarked on a major corporate-wide initiative resulting in significant improvements and clinical outcomes.