title: Adherence to hypothermia guidelines: a French multicenter study of fullterm neonates.
abstract: OBJECTIVE
  The objective of this study was to describe the French practice of hypothermia treatment (HT) in full-term newborns with hypoxic-ischemic encephalopathy (HIE) and to analyze the deviations from the guidelines of the French Society of Neonatology.
  
  
  METHODS
  From May 2010 to March 2012 we recorded all cases of HIE treated by HT in a French national database. The population was divided into three groups, "optimal HT" (OHT), "late HT" (LHT) and "non-indicated" HT (NIHT), according to the guidelines.
  
  
  RESULTS
  Of the 311 newborns registered in the database and having HT, 65% were classified in the OHT group, 22% and 13% in the LHT and NIHT groups respectively. The severity of asphyxia and HIE were comparable between newborns with OHT and LHT, apart from EEG. HT was initiated at a mean time of 12 hours of life in the LHT group. An acute obstetrical event was more likely to be identified among newborns with LHT (46%), compared to OHT (34%) and NIHT (22%). There was a gradation in the rate of complications from the NIHT group (29%) to the LHT (38%) group and the OHT group (52%). Despite an insignificant difference in the rates of death or abnormal neurological examination at discharge, nearly 60% of newborns in the OHT group had an MRI showing abnormalities, compared to 44% and 49% in the LHT and NIHT groups respectively.
  
  
  CONCLUSIONS
  The conduct of the HT for HIE newborns is not consistent with French guidelines for 35% of newborns, 22% being explained by an excessive delay in the start of HT, 13% by the lack of adherence to the clinical indications. This first report illustrates the difficulties in implementing guidelines for HT and should argue for an optimization of perinatal care for HIE.
authors.affiliation: Neonatology and Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Chevallier
authors.affiliation: Clinical Research Center (CICO3), Grenoble University Hospital, Grenoble, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Ego
authors.affiliation: THEMAS (Techniques pour l'évaluation et la modélisation des actions de santé), Joseph Fourier University-Grenoble1, Grenoble, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Cans
authors.affiliation: Neonatology and Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Debillon
mesh_terms: D001238:Asphyxia Neonatorum / Q000517:prevention & control*; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control*; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*