Timing of Therapeutic Hypothermia & Short-Term Infant Outcomes

<p><strong>Background:</strong> Hypoxic-ischemic encephalopathy (HIE) can result in devastating long-term neurological morbidity and/or death. Current evidence recommends initiating Therapeutic Hypothermia (TH), as early as possible, however, research specifically describing TH timing in relation to short-term infant outcomes is limited with mixed results.</p> <p><strong>Purpose:</strong> Examine TH timing (TH initiation time & time to target temperature) on short-term outcomes (neonatal seizure; brain injury) of infants >35weeks, with suspected HIE, born at a large urban women’s medical center.</p> <p><strong>Methodology:</strong> Retrospective, cross-sectional, correlational design examining data extracted from electronic health record from November 1, 2012- March 31, 2020. Descriptive and inferential statistics were performed.</p> <p><strong>Results</strong>: Infants with neonatal seizures had higher initial lactates (<em>M</em>=13.39, <em>SD</em>=5.31) a significant difference of 4.38mmol (95% CI -6.89 to -1.86), <em>t</em>(113)=3.44, <em>p</em>=.001; lower arterial blood gas pH values (<em>M</em>=3.331, <em>SD</em>=4.41) a difference of 0.07mEq/L (95% CI, 0.01 to 0.14), <em>t</em>(109)= 2.37,<em> p</em>=.020; fewer minutes to reach target temperature (mean rank=39.11), a significant difference (<em>U</em>= 533, <em>z</em>= -2.677, <em>p</em>= .007). Infants with brain injury had higher initial lactates (<em>M</em>= 13.04 , <em>SD</em>= 5.52) a significant difference of 4.27mmol (95% CI -6.45 to -2.07), <em>t</em>(113)= -3.85, <em>p</em>< .001; lower arterial blood gas pH values (<em>M</em>=7.12, <em>SD</em>= 0.15), a significant difference of 0.09mEq/L (95% CI 0.0 to 0.14), <em>t(</em>109)= 3.16, <em>p</em>=.002. Infants with early initiation had higher initial lactates (<em>M</em>=11.43, <em>SD</em>=4.90) a significant difference of 2.49mmol (95% CI, 0.45 to 4.52, <em>t</em>(113) =2.42, <em>p</em>= .017, <em>Cohen’s d</em>= .607). Infants within target temperature had higher initial lactates (<em>M </em>= 10.57, <em>SD</em> = 5.46) a significant difference of 2.44mmol (95% CI, 0.49 to 4.40), <em>t</em>(113) = 2.47, <em>p</em>= .015, <em>Cohen’s d</em> = .481).</p> <p><strong>Implications:</strong> Infants with neonatal seizures and/or brain injury had more acidotic cord and blood gas results, as well as higher initial lactates than those without neonatal seizures and/or brain injury. This study demonstrated the importance of TH timing, specifically time to target temperature, as infants with seizures required significantly less time to reach target temperature. A greater understanding of cord and blood gas results, initial lactates, and target temperature may increase the nurses’ ability to anticipate complications.</p>

Name thesis:degree_name

PhD Nursing

Level thesis:degree_level

Dissertation: Open Access

Discipline thesis:degree_discipline

Nursing

Year dc:date.available

2021

Author dc:creator

• Rakes, Brooke

• brain injury
• hypothermia
• neonatal seizure
• newborn outcome
• time
• Maternal, Child Health and Neonatal Nursing
• Pediatric Nursing

Repository record dc:identifier

https://digital.sandiego.edu/dissertations/198

OAI identifier oai:identifier

oai:digital.sandiego.edu:dissertations-1200