Audit of babies treated with therapeutic hypothermia in Wales in 2014 Dr.Rajarajan Kannapiran RGH, ABUHB

Contributors Dr.Shouja M A Alam (UHW) Dr.S.Banerjee (Singleton) Dr.I.Barnard (Glan Clwyd) Dr.M.Chakraborty (UHW) Dr.S.Sen (RGH)

Aim To look into babies who were cooled in Wales in 2014 and to assess if these babies qualified for treatment based on TOBY criteria

Methods Babies born over a period of one year (01/01/2014 to 31/12/2014) and who were cooled were identified from Badgernet data Retrospective analysis of circumstances around cooling and other variable were recorded and analysed

2014 Total number of babies : 78 Readmission : 14 Not actively cooled : 10 Transferred out of region : 1 Total babies cooled : 53

Hospital wise distribution

Demography M: F ratio = 1.3: 1

Summary of study variables Average Gestation at admission39.6 weeks (39+4/40) Length of stay1.6 weeks (11.4 days) Birth weight3322 gms Admission Temperature35.3°C IC care days days

TOBY criteria for cooling Babies > 36 weeks admitted to neonatal unit Criteria A (perinatal factors) Apgar 10mins Resus > 10mins pH <7.0 BD > 16 Criteria B (encephalopathy) Altered consciousness Abnormal tone Abnormal primitive reflexes

Criteria-A

Criteria-B

Samples satisfying TOBY Criteria Both criteria A & B fulfilled = 45 (84.91%) - (3 <36 weeks) Either A or B not fulfilled= 7 (13.2%) Both A & B criteria not fulfilled= 1 (1.89%) Only 42 out of 53 (79%) fulfilled TOBY criteria for cooling.

TOBY criteria and CFM Criteria A & B fulfilled and CFM normal = 13 (28.9%) Criteria A & B fulfilled and CFM abnormal = 31 (68.9%) - (3 <36 weeks) Only 28 (53%) babies fulfilled TOBY criteria and had abnormal CFM (All Wales guideline)

Time from birth to cooling

Babies actively cooled within 6 hrs Note: All inborn babies cooled within 6 hrs

CFM monitoring-timing CFM monitoringTime (mins) Inborn85.7 Outborn446.6 Average278.1

MRI abnormal n=14 3 had mild, 8 moderate and 3 severe HIE 4 did not fulfil TOBY criteria A&B and 1 had normal CFM Out of 10 that fulfilled criteria A&B, 1 had normal CFM

MRI in babies who fulfilled TOBY A&B and had normal CFM

Outcome All babies who died had severe HIE Out of the 6, 1 had Trisomy 21 & 1 had Myotubular myopathy 2 of 3 <36 week babies survived 1was cooled for 72 hrs and had normal MRI

Recommendations Time to cool for Outborn babies’ needs improvement All babies who are cooled should have CFM monitoring Babies with clinical concern may benefit from passive cooling, CFM monitoring and regular clinical assessment to decide on further management

Recommendations CFM if indicated should be started as soon as possible and if abnormal, is an indication for cooling It is important to document time of achieving target temperature and also CFM findings All babies who have been cooled should be considered for a MRI

Summary In 2014, Incidence of moderate and severe HIE in term babies was 0.95/1000 live births & Mortality rate due to HIE in term babies was 0.15/1000 live births 42 (79%) babies fulfilled TOBY criteria for cooling Only 28 (53%) babies fulfilled TOBY criteria and had abnormal CFM

Summary 13 babies who fulfilled TOBY criteria, and had normal CFM needed cooling-1 had abnormal MRI, 5 had moderate HIE We have cooled 3 preterm babies- ? Therapeutic creep- 2 survived and 1 had normal MRI Decision for cooling- ? Clinical It will be interesting to see outcome of these babies at 2 years- Bayley assessment

Thank you.... Love all! Serve all!