355 - Increasing availability of servo-controlled active therapeutic hypothermia in non-NICUs for neonatal hypoxic ischaemic encephalopathy in the UK

Publication Number: 355.5207

Aarti K. Mistry, Centre for Perinatal Research, University of Nottingham, Nottingham, England, United Kingdom; Rosalind B. Simpson, University of Nottingham, Sheffield, England, United Kingdom; Shalini Ojha, University of Nottingham, Derby, England, United Kingdom; Don Sharkey, University of Nottingham, Nottingham, England, United Kingdom

Background: Neonatal hypoxic ischaemic encephalopathy (HIE) is the largest contributor of term birth-related brain injury worldwide. Therapeutic hypothermia (TH), started within 6-hours of birth, improves survival without disability. Servo-controlled active TH (active-TH) is superior to passive cooling achieving target temperature sooner. Infants born in level 2 centres with active-TH, compared to passive cooling, are more likely to have seizure-free survival (Shipley et al 2022). Active-TH is mostly provided by tertiary NICU’s, potentially creating disparities in access to optimal care for these high-risk infants. In 2018, 276,258 (39%) UK births occurred in centres without active-TH, potentially delaying optimal TH for up to 552 infants with HIE (Mistry et al 2022).

Objective: Quantify active-TH provision across UK birthing centres and regional networks at three time points: 2011 (post adoption of active-TH as standard of care), 2018 and 2023.

Design/Methods: UK maternity/neonatal centres between Apr-Dec 2023 provided information on their provision of active-TH which was mapped to 2022/23 birth numbers obtained from national databases. Centres were also combined into their regional neonatal networks. Access to active-TH was established by unit level, regional level and number of births comparing 2011, 2018 and 2023 coverage.

Results: From 2011 to 2023, the number of UK births and maternity centres have fallen (Table). By 2020, all 15 UK transport teams provided active-TH during transfer. In 2023, 459,004 (71%) UK births had access to active-TH compared to 426,536 (61%) in 2018 (P < 0.001). The greatest uptake was observed by Level 2 units, increasing access to their births by a further 20% compared to a 6% increase in Level 1 centres. In 2023, 10 of 13 regional networks had increased their active-TH provision at birth (Figure). Based on a HIE incidence of 1-2/1000 births (Shipley et al 2021), 63-127 additional infants with HIE in 2023 received optimal active-TH at birth compared to 2018, however 189-377 infants were required to wait for arrival of the transport team to commence active-TH.

Conclusion(s): Across the UK, the provision of active-TH at birth continues to increase. However, disparities in some regions and across neonatal care levels remain resulting in sub-optimal TH for many infants at the time of decision to cool. Active-TH provision at birth could provide better neuroprotection by reaching TH earlier and reducing pressures on transport teams. Further investment in equipment provision, education and training could ensure optimal TH provision and neuroprotection, potentially improving outcomes.

Table. Provision of therapeutic hypothermia (TH) in 2011/12, 2018/19 and 2022/23, by UK maternity/neonatal centres, neonatal unit level and birth rate across level of neonatal units.
(Table) Provision of therapeutic hypothermia (TH) in 2011/12, 2018/19 and 2022/23, by UK maternity/neonatal centres, neonatal unit level and birth rate across level of neonatal units. *P <0.001 Chi squared for trend to compare births with Immediate-TH to those without Immediate-TH over time.
Abbreviations:
Immediate-TH: Active-TH available at birth centre for initiation, Transport-TH: Reliant on transport team to initiate Active-TH, Tertiary-TH: Reliant on tertiary cooling centre to initiate Active-TH.
NICU=Neonatal Intensive Care Unit; LNU=Local Neonatal Unit; SCU=Special Care Baby Unit.
a=Percentage based on total number of units within each level, b=Percentage based on total births at each level of neonatal unit.


Figure. Heat Map showing the percentage of births within UK regions, based on UK neonatal operational delivery networks, with active-TH access at birth in 2011/12, 2018/19 and 2022/23.
Figure UK Map Final .jpeg(Figure) Heat Map showing the percentage of births within UK regions, based on UK neonatal operational delivery networks, with active-TH access at birth in 2011/12, 2018/19 and 2022/23. The scale is presented as quintiles of the percentage of regional births with active-TH access. Powered by Bing © Microsoft Open Spaces.