Institutional Impact of a Neonatal Cooling Protocol on Obstetric Assessment of Newborns [20R]

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Abstract

INTRODUCTION:

Tertiary care centers have begun implementing protocols for therapeutic hypothermia for infants at high risk of hypoxic ischemic encephalopathy. The current study assesses whether the initiation of a neonatal cooling protocol is concurrently associated with a change in the assignment of newborn Apgar scores.

METHODS:

A population-level ecological analysis. The two-year pre-intervention period before neonatal cooling was from 2011–2012, and the two-year post-intervention period was from 2013–2014. Apgar scores were assessed using two cut-offs of Apgar <4 and Apgar <7 at either 1 or 5 minutes of life.

RESULTS:

During 2011–2012, there were 15,067 deliveries, and from 2013–2014 following implementation, there were 14130 deliveries. Seventy infants underwent neonatal cooling, and 373 infants had an Apgar score <7, of whom 59 had an Apgar score <4. The number of infants assigned an Apgar score <4 was over two-fold higher following implementation of neonatal cooling compared to the two years prior (66% vs 34%; P<.01). The number of infants assigned an Apgar score <7 was significantly higher post-intervention compared to pre-intervention (53% vs 47%; P<.05). The year 2014, accounting for 84% of cooled infants but only 22% of deliveries, included a disproportionate 44% of infants assigned an Apgar <4 and 30% with an Apgar <7. The above association between infants cooled and low Apgar scores held when analyzing data monthly, quarterly, and annually.

CONCLUSION:

It is possible that the implementation of a new neonatal intervention could impact the provision of newborn care by obstetric providers at the time of birth.

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