Short term outcomes of newborn infants with Hypoxic Ischaemic Encephalopathy treated with therapeutic hypothermia in a low resource setting: A retrospective cohort study

Abstract Background Hypoxic Ischemic Encephalopathy (HIE) remains a significant cause of death and neuro-developmental deficits among children, especially in resource limited settings. Therapeutic hypothermia which is the mainstay of treatment for moderate to severe hypoxic ischaemic encephalopathy in developed countries, is not widely practiced in low resource settings and the available data is limited. We aimed to determine the short term outcomes and factors associated with survival among newborn infants with moderate to severe hypoxic ischaemic encephalopathy treated with therapeutic hypothermia at St. Francis Hospital, Nsambya. Methods Retrospective cohort study of 81 newborn infants with moderate to severe HIE who were 36 weeks and above that were cooled from June 2016 to February 2019, at St. Francis Hospital, Nsambya, Kampala, Uganda. Data on maternal and infant characteristics, clinical outcomes were extracted from the HIE registry and HIE follow up forms. Descriptive analysis was done to get the patient characteristics. Survival analysis was done to compare outcome among the groups of infants with significant factors at bivariate analysis. Multiple cox proportional hazards regression analysis was done to determine the factors independently associated with survival. Results The proportion of newborn infants who survived was 68/81(84%), (95%: CI: 0.74, 0.91).The factors associated with survival were a Thompson score of 7 to10 at initiation of cooling(HR: 0.07, 95% CI: 0.01, 0.94) and at 24 hours of cooling(HR:0.03, 95%CI: 0.004, 0.21), being born within the hospital providing therapeutic hypothermia (HR: 0.26, 95% CI: 0.07, 0.94) and not needing mechanical ventilator (HR: 0.03, 95% CI: 0.01, 0.14) or inotropic support.(HR: 0.13, 95%CI: 0.04, 0.38). The median time to attainment of full cup feeds was 6 days, with the majority 43/68(63%) attaining full feeds from 5 to 8 days. The median time to discharge was 7 days, and the median time to death was 3 days. The median Thompson score at discharge was 1 and at death was 16 Conclusion The survival rate of cooled infants in our setting at 84% is comparably high. The majority of infants have normal neurology at discharge.

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Changes in Oxygenation and Clinical Outcomes with Awake Prone Positioning in Patients with Suspected COVID-19 In Low-Resource Settings: A Retrospective Cohort Study

Journal of Intensive Care Medicine ◽

10.1177/08850666211049333 ◽

2021 ◽

Vol 36 (11) ◽

pp. 1347-1353

Author(s):

Carmelo Dueñas-Castell ◽

Diana Borre-Naranjo ◽

Dairo Rodelo ◽

Leydis Lora ◽

Amilkar Almanza ◽

...

Keyword(s):

Cohort Study ◽

Respiratory Failure ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prone Positioning ◽

Low Resource Settings ◽

Low Resource ◽

Resource Setting ◽

Tertiary Center ◽

Rank Difference

Introduction This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. Methods This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020. Demographic, clinical, and laboratory variables were collated, and all the variables were compared between the groups. Results The median age of the participants was 63 (IQR, 48.8-73) years (survivors: 59 [IQR, 43.568] years vs. non-survivors: 70 [IQR, 63-78] years, P ≤ .001). Of the 1470 patients admitted for respiratory symptoms, 732 (49.8%) were hospitalized for more than 24 h, and 212 patients developed respiratory failure and required COT and APP (overall hospital mortality, 34% [73/212]). The mean rank difference in PaO2/FiO2 before and after APP was higher in the survivors than in the non-survivors (201.1-252.6, mean rank difference = 51.5, P = .001 vs. 134.1-172.4, mean rank difference = 38.28, P = .24, respectively). Conclusion While using COT in conjunction with APP can improve respiratory failure in patients with suspected COVID-19 in low-resource settings, persistent hypoxemia after APP can identify patients with higher mortality risk. More evidence is needed to establish the role of this strategy.

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Correction to: Waterbirth: a national retrospective cohort study of factors associated with its use among women in England

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03871-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

H. Aughey ◽

◽

J. Jardine ◽

N. Moitt ◽

K. Fearon ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Factors Associated

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Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049089 ◽

2021 ◽

Vol 11 (5) ◽

pp. e049089

Author(s):

Marcia C Castro ◽

Susie Gurzenda ◽

Eduardo Marques Macário ◽

Giovanny Vinícius A França

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Proportional Hazards ◽

Secondary Outcome ◽

Hospital Death ◽

Factors Associated ◽

Icu Admission ◽

Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

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