Association of Outborn versus Inborn Birth Status on the In-hospital Outcomes of Neonates Treated with Therapeutic Hypothermia: A Propensity Score-Weighted Cohort Study

Resuscitation ◽  
2021 ◽  
Author(s):  
Raymond C. Stetson ◽  
Jane E. Brumbaugh ◽  
Amy L. Weaver ◽  
Kristin C. Mara ◽  
Reese H. Clark ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Therapeutic Hypothermia ◽  
Hospital Outcomes

scholarly journals Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis

2021 ◽  
pp. fetalneonatal-2020-320966
Author(s):  
Lara Shipley ◽  
Aarti Mistry ◽  
Don Sharkey
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Therapeutic Hypothermia ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Research Database ◽  
Short Term ◽  
Free Survival ◽  
Secondary Outcomes ◽  
Level 2

ObjectiveTherapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes.DesignRetrospective cohort study using National Neonatal Research Database and propensity score-matching.SettingUK neonatal units.PatientsInfants ≥36 weeks gestational age with moderate or severe HIE admitted 2011–2016.InterventionsBirth in non-CC compared with CC.Main outcome measuresPrimary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer.Results5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth.ConclusionsAlmost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.

scholarly journals 381In-hospital mortality for infants with HIE who received therapeutic hypothermia: a propensity score-matched cohort study

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Krista Wollny ◽  
Khorshid Mohammad ◽  
Stephen Wood ◽  
Matthew Hicks ◽  
Janice Skiffington ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Therapeutic Hypothermia ◽  
Task Force ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Average Treatment Effect ◽  
Risk Of Mortality

Abstract Background In 2016, the Academic Medical Center Neonatal Encephalopathy Task Force recommended therapeutic hypothermia (TH) as the standard-of-care for hypoxic ischemic encephalopathy (HIE). However, not all infants who meet the criteria for TH receive this treatment. The purpose of this study was to compare the risk of mortality for infants with HIE who did and did not receive TH, after accounting for confounders associated with receipt of TH. Methods A retrospective cohort study was conducted using the 2016 National Inpatient Sample (NIS), which contains 20% of all hospital discharges in the United States. Infants were included if they were diagnosed with HIE and were eligible for TH. Nearest-neighbor propensity score-matching (1:1) without replacement was performed prior to logistic regression analysis. The average treatment effect of TH was calculated to estimate the odds of mortality. Results There were 211 infants with HIE who received TH, which is an estimated proportion of 24.8% (95% CI: 20.9-29.1%). Infants who received TH were more likely to have a seizure (p < 0.05), be transferred from another hospital (p < 0.001), and have the highest Risk of Mortality scores (p < 0.05). The odds of mortality were 0.91 (95% CI: 0.85-0.97) for infants that received TH, compared to those who did not. Conclusions Receipt of TH varied across patient groups and was associated with clinical risk factors. The odds of in-hospital mortality were lower in infants who received TH. Key messages Infants who received TH had a decreased risk of in-hospital mortality compared to infants who did not receive TH.

scholarly journals Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tadashi Matsuoka ◽  
Nao Ichihara ◽  
Hiroharu Shinozaki ◽  
Kenji Kobayashi ◽  
Alan Kawarai Lefor ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Blood Loss ◽  
Emergency Surgery ◽  
Retrospective Cohort ◽  
Confounding Factors ◽  
Intraoperative Blood Loss ◽  
Antithrombotic Drugs ◽  
Generalized Peritonitis ◽  
Blood Loss Volume

Abstract Background The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan. Method This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates. Results A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery. Conclusion This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

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