https://orcid.org/0000-0002-3568-7282
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Khorshid Mohammad, Dinesh Dharel, Ayman Abou Mehrem, Michael J Esser, Renee Paul, Hussein Zein, James N Scott, Elsa Fiedrich, Prashanth Murthy, Salma Dossani, Kaley Kopores, Derek Kowal, John Montpetit, Essa Al Awad, Sumesh Thomas, Impact of outreach education program on outcomes of neonates with hypoxic ischemic encephalopathy, Paediatrics & Child Health, Volume 26, Issue 5, August 2021, Pages e215–e221, https://doi.org/10.1093/pch/pxaa075
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Abstract
To evaluate the impact of outreach education targeting neuroprotection on outcomes of outborn infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE).
A retrospective cohort study of infants admitted with moderate-to-severe HIE was conducted following the implementation of outreach education in January 2016. Key interventions were early identification and referral of infants with encephalopathy utilizing telemedicine and a centralized communication system, hands-on simulation, and interactive case discussion and dissemination of clinical management guidelines and educational resources. The association between the intervention and a composite outcome of death and/or severe brain injury on brain magnetic resonance imaging (MRI) was tested controlling for the confounding factors.
Of 165 neonates, 37 (22.4%) died and/or had a severe brain injury. This outcome decreased from 35% (27/77) to 11% (10/88) following the implementation of outreach education (P<0.001). Eligible infants not undergoing therapeutic hypothermia within 6 hours from birth decreased from 19.5% (15/77) to 4.5% (4/88). The use of inotropes decreased from 49.3% (38/77) to 19.6% (13/88). Any core temperature below 33°C was recorded for 20/53 (38%) before and 16/78 (21%) after, while those within the target range of 33°C to 34°C at admission to a tertiary care facility increased from (15/53) 28% to (51/88) 58%. Outreach education was independently associated with decreased composite outcome of death and/or severe brain injury on MRI (adjusted odds ratio 0.2; 95% confidence interval 0.07 to 0.52).
Outreach education targeting neuroprotection for infants with moderate-to-severe HIE was associated with a reduction in death and/or severe brain injury.
