(93) Harnessing a Neonatal Encephalopathy Registry for Regional Quality Improvement Efforts

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is a severe neurologic injury that commonly results in long-term neurodevelopmental impairment. The only currently approved neuroprotective intervention for HIE is therapeutic hypothermia, which decreases the incidence of mortality and severe disability. Optimizing clinical care for infants with HIE is challenging due to the paucity of large prospective multi-center randomized trials assessing adjunctive care for impacted newborns treated with therapeutic hypothermia.

Objectives: Improve regional clinical care for infants with neonatal encephalopathy presumed to be due to HIE through a regional clinical data registry.

Design/Methods: We developed a regional multicenter registry of newborns at risk for HIE (Figure 1 provides the inclusion flow diagram) and leveraged the data collected within the registry to design and monitor biannually three initial metrics chosen by registry investigators: increasing the rate of acquisition of cord blood gas in high-risk deliveries; increasing documentation of neurological exam and encephalopathy scores in infants with perinatal acidosis; and decreasing the incidence of infants discharged on anti-seizure medication. Metric-targeted interventions over time are demonstrated in Figure 2. Perinatal acidosis was defined as pH < 7.1 and/or base deficit>12 on cord or initial ( < 1 hour) neonatal blood gas.

Results: Table 1 describes the overall subject demographics of neonates included in the registry, stratified by whether the infants underwent therapeutic hypothermia. The data demonstrated positive trends in all three initial metrics (Figure 2). So far, we have seen (B) a significant shift in increased documentation of encephalopathy scores in infants with perinatal acidosis; (C) two recent positive runs in the percent of high-risk infants (sentinel events and/or 5-minute Apgar < 5) with a cord blood gas or neonatal gas within the first hour of life obtained; and (D) a short run for the past three halves in decreasing the rate of infants undergoing hypothermia with seizures who were discharged on anti-seizure medication.

Conclusions: Local and regional registries can provide hypothesis-generating research data but can also be successfully leveraged for quality improvement efforts across multiple hospitals. While we have yet to meet the final goal thresholds for each of those efforts, current progress has shown that we are approaching them, and with ongoing efforts, we may be able to soon reach the optimal clinical goals that we set.