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Winiyom P, Janyoungsak P, Narkwichean A, Khuancharee K, Laosooksathit W. A cost-effectiveness analysis of using umbilical cord blood pH for the diagnosis and management of neonatal asphyxia in term high-risk pregnancy. Int J Gynaecol Obstet 2024. [PMID: 38619288 DOI: 10.1002/ijgo.15540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The objective was to evaluate the cost-effectiveness of using umbilical cord blood pH (UC-pH) in combination with APGAR score for neonatal asphyxia, in terms of high-risk pregnancies, compared to using the APGAR score only. Neonatal outcomes and the proportions of patients admitted to the neonatal intensive care unit (NICU) were evaluated. METHODS A cost-effectiveness ambispective analysis study was carried out, comparing (i) UC-pH combined with APGAR score and (ii) APGAR score only in 399 term pregnancies with a high risk for neonatal asphyxia. Costs included implementation, medical, and admission costs. Incremental cost-effectiveness ratios (ICER) were calculated. The proportions of patients admitted to the NICU were evaluated. RESULTS UC-pH combined with APGAR score demonstrated a cost-effective outcome (3990.64 USD vs 5545.11 USD) and an ICER shown as saving 103.66 USD compared to the APGAR score alone. The need for NICU admission was less in the umbilical cord blood collection group (18 vs 33 cases). CONCLUSION A combination of UC-pH with APGAR score assessment for neonatal asphyxia in a high-risk term pregnancy can effectively reduce costs and requirement for NICU admission.
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Affiliation(s)
- Patipan Winiyom
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Pornpimon Janyoungsak
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Amarin Narkwichean
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Wipada Laosooksathit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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J A, S S, P W, S W, P B, K M. Quality improvement and outcomes for neonates with hypoxic-ischemic encephalopathy: obstetrics and neonatal perspectives. Semin Perinatol 2024; 48:151904. [PMID: 38688744 DOI: 10.1053/j.semperi.2024.151904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Despite significant improvement in perinatal care and research, hypoxic ischemic encephalopathy (HIE) remains a global healthcare challenge. From both published research and reports of QI initiatives, we have identified a number of distinct opportunities that can serve as targets of quality improvement (QI) initiatives focused on reducing HIE. Specifically, (i) implementation of perinatal interventions to anticipate and timely manage high-risk deliveries; (ii) enhancement of team training and communication; (iii) optimization of early HIE diagnosis and management in referring centers and during transport; (iv) standardization of the approach when managing neonates with HIE during therapeutic hypothermia; (v) and establishment of protocols for family integration and follow-up, have been identified as important in successful QI initiatives. We also provide a framework and examples of tools that can be used to support QI work and discuss some of the perceived challenges and future opportunities for QI targeting HIE.
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Affiliation(s)
- Afifi J
- Department of Pediatrics, Neonatal-Perinatal Medicine, Dalhousie University, 5980 University Avenue, Halifax B3K6R8, Nova Scotia, Canada.
| | - Shivananda S
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of British Columbia, Canada
| | - Wintermark P
- Department of Pediatrics, Neonatal-Perinatal Medicine, McGill University, Canada
| | - Wood S
- Department of Obstetrics and Gynecology, University of Calgary, Canada
| | - Brain P
- Department of Obstetrics and Gynecology, University of Calgary, Canada
| | - Mohammad K
- Department of Pediatrics, Section of Newborn Intensive Care, University of Calgary, Canada
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Peebles PJ, Christ L, Flibotte J, Presser L, Carr LH. Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices. J Perinatol 2024:10.1038/s41372-024-01916-4. [PMID: 38424232 DOI: 10.1038/s41372-024-01916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
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.
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Affiliation(s)
- Patrick J Peebles
- Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Lori Christ
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Flibotte
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Liandra Presser
- Division of Neonatology, Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA, USA
| | - Leah H Carr
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Kazanasmaz H, Akan A, Yalçın Ö, Ölçücü MT, Onar S, Kazanasmaz Ö. Cerebral Tissue Oxygen Saturation Measurements in Perinatal Asphyxia Cases Treated with Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2023; 13:184-190. [PMID: 36920248 DOI: 10.1089/ther.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy (NIRS) technology has recently become the subject of several research studies. The aim of this study was to investigate the diagnostic value of CrSO2 measurements in perinatal asphyxia (PA) cases. The study included a patient group of 42 PA cases, who were to be applied with therapeutic hypothermia (TH), and a control group of 42 healthy term newborns. PA cases were determined as moderate or severe encephalopathy (Sarnat score stage II or III) in clinical evaluation. In both groups, left (CrSO2L) and right (CrSO2R) NIRS measurements were taken for 10 minutes on the scalp. The arithmetic mean value of measurements was calculated and compared. The mean measurements were CrSO2R 67.38 ± 9.39 and CrSO2L 66.73 ± 7.76 in the patient group, and CrSO2R 80.28 ± 8.04 and CrSO2L 79.14 ± 8.49 in the control group. The mean CrSO2R and CrSO2L measurements of the patient group were statistically significantly lower than those of the control group (p < 0.001). In the Pearson correlation analysis, a significant correlation was determined in the patient group between cord blood gas pH and CrSO2R (r: 0.539, p < 0.001) and CrSO2L (r: 0.54, p < 0.001). For a cutoff value of CrSO2L ≤ 72%, the positive predictive value was 80 and the negative predictive value was 84.6. For a cutoff value of CrSO2R ≤ 74%, the positive predictive value was 79.5 and the negative predictive value was 82.5. Low CrSO2 measurements obtained with the NIRS method in PA cases to be applied with TH together with cord blood gas parameters can be considered a helpful parameter in diagnosis.
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Affiliation(s)
- Halil Kazanasmaz
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Abdulsamed Akan
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ömer Yalçın
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | | | - Selehattin Onar
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Özlem Kazanasmaz
- Department of Pediatrics Sanliurfa, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
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Geva N, Geva Y, Salem SY, Marks KA, Rotem R, Abramsky R, Hershkovitz R, Shelef I, Novik EF, Weintraub AY, Shany E. The association of intrapartum deceleration and acceleration areas with MRI findings in neonatal encephalopathy. Pediatr Res 2023; 94:1119-1124. [PMID: 36964444 DOI: 10.1038/s41390-023-02575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/11/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is an important contributor to disability worldwide. The current cardiotocography (CTG) predictive value for neonatal outcome is limited. OBJECTIVE To assess the association of intrapartum CTG deceleration and acceleration areas with early MRI cerebral pathology in infants with HIE. METHODS Term and near-term low-risk pregnancies that resulted in HIE, treated with therapeutic hypothermia with sufficient CTG records from a single, tertiary hospital between 2013 and 2021 were enrolled. Accelerations and decelerations areas, their minimum and maximum depths, and duration were calculated as well as the acceleration-to-deceleration area ratio during the 120 min prior to delivery. These data were assessed for associations with higher degrees of abnormality on early MRI scans. RESULTS A total of 77 infants were included in the final analysis. Significant associations between increased total acceleration area (p = 0.007) and between a higher acceleration-to-deceleration area ratio (p = 0.003) and better MRI results were detected. CONCLUSION In neonates treated for HIE, acceleration area and acceleration-to-deceleration ratio are associated with the risk of neonatal brain MRI abnormalities. To increase the role of these measurements as a relevant clinical tool, larger, more powered prospective trials are needed, using computerized real-time analysis. IMPACT The current cardiotocography predictive value for neonatal outcome is limited. This study aimed to assess the association of intrapartum deceleration and acceleration areas with the degree of cerebral injury in early cerebral MRI of neonates with encephalopathy. Lower acceleration area and acceleration-to-deceleration ratio were found to be associated with a higher degree of neonatal brain injury. Brain MRI is a marker of long-term outcome; its association with cardiotocography indices supports their association with long-term outcome in these neonates. Future computer-based CTG area analysis could assist in delivery room decision making to better time interventions and prevent hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Neta Geva
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel.
| | - Yael Geva
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Kyla Anna Marks
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Reut Rotem
- Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Ramy Abramsky
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Ilan Shelef
- Department of Medical Imaging, Soroka Medical Center and the, Ben-Gurion University of the Negev Zlotowski Center for Neuroscience, Beer-Sheva, Israel
| | - Evelyn Farkash Novik
- Department of Medical Imaging, Soroka Medical Center and the, Ben-Gurion University of the Negev Zlotowski Center for Neuroscience, Beer-Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Eilon Shany
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
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