Multicenter program for the integrated care of newborns with perinatal hypoxic-ischemic insult (ARAHIP)

作者：Arnaez J^*; Vega C; Garcia Alix A; Gutierrez E P; Caserio S; Jimenez M P; Castanon L; Esteban I; Hortelano M; Hernandez N; Serrano M; Prada T; Diego P; Barbadillo F

来源：Anales de Pediatria, 2015, 82(3): 172-182.

DOI：10.1016/j.anpedi.2014.05.006

• Perinatalasphyxia
• Hypoxic-ischemic encephalopathy
• Clinical pathway
• Program

Introduction: Newborns with perinatal indicators of a potential hypoxic-ischemic event require an integrated care in order to control the aggravating factors of brain damage, and the early identification of candidates for hypothermia treatment.
Patients and methods: The application of a prospective, populational program that organizes and systematizes medical care during the first 6 hours of life to all newborns over 35 weeks gestational age born with indicators of a perinatal hypoxic-ischemic insult. The program includes 12 hospitals (91,217 m(2)); two level 1 centers, five level II centers, and five level III hospitals. The program establishes four protocols: a) detection of the newborn with a potential hypoxic-ischemic insult, b) surveillance of the neurological repercussions and other organ involvement, c) control and treatment of complications, d) procedures and monitoring during transport.
Results: From June 2011 to June 2013, 213 of 32325 newborns above 35 weeks gestational age met the criteria of a potential hypoxic-ischemic insult (7.4/1000), with 92% of them being cared for following the program specifications. Moderate-severe hypoxic-ischemic encephalopathy was diagnosed in 33 cases (1/1,000), and 31 out of the 33 received treatment with hypothermia (94%).
Conclusions: The program for the Integrated Care of Newborns with Perinatal Hypoxic-Ischemic Insult has led to providing a comprehensive care to the newborns with a suspected perinatal hypoxic-ischemic insult. Aggravators of brain damage have been controlled, and cases of moderate-severe hypoxic-ischemic encephalopathy have been detected, allowing the start of hypothermia treatment within the first six hours of life. Populational programs are fundamental to reducing the mortality and morbidity of hypoxic-ischemic encephalopathy.

• 出版日期2015-3