title: A quantitative analysis of optimal treatment capacity for perinatal asphyxia.
abstract: In centers electing to offer therapeutic hypothermia for treating hypoxic-ischemic encephalopathy (HIE), determining the optimal number of cooling devices is not straightforward. The authors used computer-based modeling to determine the level of service as a function of local HIE caseload and number of cooling devices available.
  
  
  
  The authors used discrete event simulation to create a model that varied the number of HIE cases and number of cooling devices available. Outcomes of interest were percentage of HIE-affected infants not cooled, number of infants not cooled, and percentage of time that all cooling devices were in use.
  
  
  
  With 1 cooling device, even the smallest perinatal center did not achieve a cooling rate of 99% of eligible infants. In contrast, 2 devices ensured 99% service in centers treating as many as 20 infants annually. In centers averaging no more than 1 HIE infant monthly, the addition of a third cooling device did not result in a substantial reduction in the number of infants who would not be cooled.
  
  
  
  Centers electing to offer therapeutic hypothermia with only a single cooling device are at significant risk of being unable to provide treatment to eligible infants, whereas 2 devices appear to suffice for most institutions treating as many as 20 annual HIE cases. Three devices would rarely be needed given current caseloads seen at individual institutions. The quantitative nature of this analysis allows decision makers to determine the number of devices necessary to ensure adequate availability of therapeutic hypothermia given the HIE caseload of a particular institution.
authors.affiliation: Department of Neonatology (AG, JG) Beth Israel-Deaconess Medical Center, Boston, MA|Division of Newborn Medicine, Harvard Medical School, Boston, MA (AG, JG)
authors.forename: Alon
authors.initials: A
authors.lastname: Geva
authors.affiliation: Division of Clinical Informatics (JG) Beth Israel-Deaconess Medical Center, Boston, MA|Division of Newborn Medicine, Harvard Medical School, Boston, MA (AG, JG)
authors.forename: James
authors.initials: J
authors.lastname: Gray
mesh_terms: D001238:Asphyxia Neonatorum / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D006276:Health Facility Size / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data*; D020925:Hypoxia-Ischemia, Brain / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D017211:Treatment Failure; D014481:United States