Document Detail


Effect of inborn vs. outborn delivery on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy: secondary analyses of the NICHD whole-body cooling trial.
MedLine Citation:
PMID:  22914450     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The effect of birth location on hypothermia-related outcomes has not been rigorously examined in the literature. In this study, we determined whether birth location had an impact on the benefits of whole-body cooling to 33.5 °C for 72 h in term infants (n = 208) with hypoxic-ischemic encephalopathy (HIE) who participated in the Neonatal Research Network (NRN) randomized controlled trial.
METHODS: Heterogeneity by birth location was examined with respect to cooling treatment for the 18-mo primary outcomes (death, moderate disability, severe disability) and secondary outcomes (death, components of disability), and in-hospital organ dysfunction. Logistic regression models were used to generate adjusted odds ratios.
RESULTS: Infants born at a location other than an NRN center (outborn) (n = 93) experienced significant delays in initiation of therapy (mean (SD): 5.5 (1.1) vs. 4.4 (1.2) h), lower baseline temperatures (36.6 (1.2) vs. 37.1 (0.9) °C), and more severe HIE (43 vs. 29%) than infants born in an NRN center (inborn) (n = 115). Maternal education <12 y (50 vs. 14%) and African-American ethnicity (43 vs. 25%) were more common in the inborn group. When adjusted for NRN center and HIE severity, there were no significant differences in 18-mo outcomes or in-hospital organ dysfunction between inborn and outborn infants.
CONCLUSION: Although limited by sample size and some differences in baseline characteristics, the study showed that birth location does not appear to modify the treatment effect of hypothermia after HIE.
Authors:
Girija Natarajan; Athina Pappas; Seetha Shankaran; Abbot R Laptook; Michele Walsh; Scott A McDonald; Richard A Ehrenkranz; Jon E Tyson; Ronald N Goldberg; Rebecca Bara; Rosemary D Higgins; Abhik Das; Breda Munoz
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-07-25
Journal Detail:
Title:  Pediatric research     Volume:  72     ISSN:  1530-0447     ISO Abbreviation:  Pediatr. Res.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-03     Completed Date:  2013-03-05     Revised Date:  2013-08-12    
Medline Journal Info:
Nlm Unique ID:  0100714     Medline TA:  Pediatr Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  414-9     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Wayne State University, Detroit, Michigan, USA. gnatara@med.wayne.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Body Temperature*
Chi-Square Distribution
Child Development*
Developmental Disabilities / diagnosis,  etiology*,  mortality,  physiopathology
Disability Evaluation
Female
Health Services Accessibility
Home Childbirth
Hospitals
Humans
Hypothermia, Induced* / adverse effects,  mortality
Hypoxia-Ischemia, Brain / mortality,  physiopathology,  therapy*
Infant, Newborn
Logistic Models
Male
Nervous System / physiopathology*
Neuropsychological Tests
Odds Ratio
Patient Transfer
Residence Characteristics*
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Time-to-Treatment
Treatment Outcome
United States
Young Adult
Grant Support
ID/Acronym/Agency:
M01 RR125/RR/NCRR NIH HHS; M01 RR16587/RR/NCRR NIH HHS; M01 RR30/RR/NCRR NIH HHS; M01 RR32/RR/NCRR NIH HHS; M01 RR39/RR/NCRR NIH HHS; M01 RR44/RR/NCRR NIH HHS; M01 RR6022/RR/NCRR NIH HHS; M01 RR633/RR/NCRR NIH HHS; M01 RR70/RR/NCRR NIH HHS; M01 RR750/RR/NCRR NIH HHS; M01 RR80/RR/NCRR NIH HHS; M01 RR8084/RR/NCRR NIH HHS; U10 HD021385/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21397/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD36790/HD/NICHD NIH HHS; U10 HD40461/HD/NICHD NIH HHS; U10 HD40492/HD/NICHD NIH HHS; U10 HD40521/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS; UL1 RR24139/RR/NCRR NIH HHS
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