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

    loading  Checking for direct PDF access through Ovid



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.


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.


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.


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.

Related Topics

    loading  Loading Related Articles