Earlier Initiation of Therapeutic Hypothermia by Non-Tertiary Neonatal Units in Victoria, Australia
Bibliographic record
Abstract
BACKGROUND: Therapeutic hypothermia is an effective treatment for moderate or severe hypoxic-ischaemic encephalopathy (HIE), with maximal neuroprotective benefit when initiated soon after birth. Early initiation of therapeutic hypothermia in infants with HIE born in geographically distant settings is challenging. OBJECTIVE: To audit temperature control in infants with HIE treated with hypothermia during neonatal transport in Victoria, Australia. METHODS: A retrospective database review from September 1, 2008 to August 31, 2012 compared temperatures of transported outborn infants with HIE treated with hypothermia initiated by the referring non-tertiary neonatal unit, with hypothermia initiated by the transport team. RESULTS: 123 infants received therapeutic hypothermia during the study period. Hypothermia treatment commenced significantly earlier [median (interquartile range [IQR]) 1.1 h (0.6-1.7) vs. 3.3 h (2.1-4.5); p < 0.01] with the target temperature (33-34°C) achieved sooner [median (IQR) 3.4 h (2.4-4.6) vs. 4.5 h (3.6-5.5)] when initiated by the referring hospital (n = 71) than by the transport team (n = 52). There was no statistically significant difference in achieving the target temperature before admission to the tertiary neonatal intensive care unit when hypothermia was initiated by the referring unit, compared with by the transport team [51/71 (71.8%) vs. 28/52 (53.9%), odds ratio (95% CI) 2.19 (0.96, 4.96)]. Infants in whom hypothermia was initiated by the referring hospital were more likely to have a recorded temperature below 33°C [22/71 (31.0%) vs. 4/52 (7.7%), odds ratio (95% CI) 5.39 (1.64, 22.83)]. CONCLUSIONS: The target temperature is achieved sooner in infants with moderate or severe HIE when therapeutic hypothermia is initiated by referring non-tertiary neonatal units under guidance from the regional transport service. This practice may enhance neuroprotection for infants with HIE born in non-tertiary units, particularly in remote locations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".