title: The impact of a register on the management of neonatal cooling in Switzerland.
abstract: BACKGROUND
  Therapeutic hypothermia following hypoxic ischaemic encephalopathy in term infants was introduced into Switzerland in 2005. Initial documentation of perinatal and resuscitation details was poor and neuromonitoring insufficient. In 2011, a National Asphyxia and Cooling Register was introduced.
  
  
  OBJECTIVE
  To compare management of cooled infants before and after introduction of the register concerning documentation, neuromonitoring, cooling methods and evaluation of temperature variability between cooling methods.
  
  
  METHODS
  Data of cooled infants before the register was in place (first time period: 2005-2010) and afterwards (second time period: 2011-2012) was collected with a case report form.
  
  
  RESULTS
  150 infants were cooled during the first time period and 97 during the second time period. Most infants were cooled passively or passively with gel packs during both time periods (82% in 2005-2010 vs 70% in 2011-2012), however more infants were cooled actively during the second time period (18% versus 30%). Overall there was a significant reduction in temperature variability (p < 0.001) comparing the two time periods. A significantly higher proportion of temperature measurements within target temperature range (72% versus 77%, p < 0.001), fewer temperature measurements above (24% versus 7%, p < 0.001) and more temperatures below target range (4% versus 16%, p < 0.001) were recorded during the second time period. Neuromonitoring improved after introduction of the cooling register.
  
  
  CONCLUSIONS
  Management of infants with HIE improved since introducing the register. Temperature variability was reduced, more temperature measurements in the target range and fewer temperature measurements above target range were observed. Neuromonitoring has improved, however imaging should be performed more often.
authors.affiliation: Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland. Electronic address: Barbara.brotschi@kispi.uzh.ch.
authors.forename: Barbara
authors.initials: B
authors.lastname: Brotschi
authors.affiliation: Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
authors.forename: Beate
authors.initials: B
authors.lastname: Grass
authors.affiliation: Clinic of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ramos
authors.affiliation: Child Development Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Beck
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer, University Hospital Zurich, Pestalozzistrasse 24, 8091 ZurichSwitzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.affiliation: Clinic of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hagmann
authors.forename: Ph
authors.initials: P
authors.lastname: Meyer
authors.forename: G
authors.initials: G
authors.lastname: Zeilinger
authors.forename: S M
authors.initials: SM
authors.lastname: Schulzke
authors.forename: S
authors.initials: S
authors.lastname: Wellmann
authors.forename: B
authors.initials: B
authors.lastname: Wagner
authors.forename: K
authors.initials: K
authors.lastname: Daetwyler
authors.forename: M
authors.initials: M
authors.lastname: Nelle
authors.forename: W
authors.initials: W
authors.lastname: Bär
authors.forename: B
authors.initials: B
authors.lastname: Scharrer
authors.forename: J-F
authors.initials: JF
authors.lastname: Tolsa
authors.forename: A
authors.initials: A
authors.lastname: Truttmann
authors.forename: J
authors.initials: J
authors.lastname: Schneider
authors.forename: R E
authors.initials: RE
authors.lastname: Pfister
authors.forename: T M
authors.initials: TM
authors.lastname: Berger
authors.forename: M
authors.initials: M
authors.lastname: Fontana
authors.forename: J P
authors.initials: JP
authors.lastname: Micallef
authors.forename: A
authors.initials: A
authors.lastname: Birkenmayer
authors.forename: H U
authors.initials: HU
authors.lastname: Bucher
authors.forename: G
authors.initials: G
authors.lastname: Natalucci
authors.forename: M
authors.initials: M
authors.lastname: Adams
authors.forename: B
authors.initials: B
authors.lastname: Frey
authors.forename: V
authors.initials: V
authors.lastname: Bernet
authors.forename: B
authors.initials: B
authors.lastname: Latal
mesh_terms: D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D011996:Records; D013557:Switzerland
keywords: Hypoxic ischaemic encephalopathy; Register; Therapeutic hypothermia