A national survey of therapeutic facilities for managing hypoxic ischaemic encephalopathy in tertiary neonatal wards in South African public hospitals
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Abstract
Background. A 2011 South African (SA) survey noted substantial variability in provision of therapeutic hypothermia (TH) for moderate- severe neonatal encephalopathy due to suspected hypoxic-ischaemic encephalopathy (NESHIE).
Objectives. To describe facilities, including TH, for babies with NESHIE in SA tertiary/specialised public hospitals.
Methods. A survey was emailed to representatives of all public tertiary/specialised hospitals with tertiary neonatal beds in SA. The survey contained questions regarding bed numbers, equipment, staffing, follow-up and barriers to the implementation of TH.
Results. Responses were received from all 25 hospitals across the nine provinces. Most hospitals (n/N=22/25; 88%) provided TH (median (range) per province: 2 (1 - 8)). The hospitals providing TH had more total neonatal beds (p=0.011) and more admissions with moderate- severe NESHIE (p=0.008) compared with those not providing TH. Most cooling centres (n/N=20/22; 91%) provided TH in their NICUs; six of these also cooled at lower levels of care. There was access to amplitude integrated electroencephalography (aEEG) and automated cooling in 91% of cooling centres. Manual cooling was used by 50% if automated TH was not available, 82% of which were validated methods. Late arrival was the most frequent barrier to provision of TH (80%).
Conclusion. All provinces and most tertiary/specialised hospitals with tertiary neonatal beds in SA provided TH in 2023. The use of acceptable monitoring and cooling methods was widespread but insufficient, and some cooling methods in use were not validated. National registers and standardised protocols for patient selection and management are needed.
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