Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices

Patrick J Peebles; Lori Christ; John Flibotte; Liandra Presser; Leah H Carr

doi:10.1038/s41372-024-01916-4

Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices

J Perinatol. 2024 Feb 29. doi: 10.1038/s41372-024-01916-4. Online ahead of print.

Authors

Patrick J Peebles¹, Lori Christ^{2

3}, John Flibotte^{2

3}, Liandra Presser⁴, Leah H Carr^{2

3

5}

Affiliations

¹ Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. pjpeebles@wisc.edu.
² Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁴ Division of Neonatology, Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA, USA.
⁵ Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 38424232
DOI: 10.1038/s41372-024-01916-4

Abstract

Background: Infants at risk for hypoxic ischemic encephalopathy (HIE) require a time sensitive evaluation and decision-making regarding treatment with therapeutic hypothermia (TH). Prior to this project, there was no standardized approach to evaluating these infants locally.

Methods: Included infants were "at risk for HIE," defined as meeting the "patient characteristics" and "biochemical criteria" per the institutional HIE pathway. Our primary outcome was documentation of an HIE therapeutic hypothermia evaluation (HIETHE) within the first six hours of life which included: (1) recognition of at-risk status, (2) an encephalopathy exam, and (3) a decision regarding TH. Plan-Do-Study-Act cycles included novel clinical decision support.

Results: From October 2020 to May 2023, among infants at-risk for HIE, the average percentage with an HIETHE documented improved from 47% to 82%.

Conclusions: We standardized the approach to infants at risk for HIE and improved the presence of a complete and timely evaluation regarding TH eligibility.