57: Therapeutic Hypothermia (TH) for Newborns with Hypoxic-Ischemic Encephalopathy (HIE): Audit of the Edmonton Experience
Bibliographic record
Abstract
TH use within 6 h of birth in newborns with HIE reduces the risk of death and neurologic impairment. The Northern Alberta Neonatal program provides a regionalized service covering a catchment area of 440,000 square kilometers. TH became a standard of care in Edmonton since July 2006. Audit the implementation of TH for HIE in a regionalized setting including initiation in referral centres from July 2006 to September 2013. This is a prospective review of newborns ≥35 weeks with HIE and <6 h old on initiation of TH . A stepwise protocol of a qualifying perinatal event (one of acidosis [pH <7.0 or BE ≥−16 by arterial cord or gas ≤1 h of age], Apgar score [≤5 at 10'] or continued resuscitation at 10') followed by an abnormal neurological exam of moderate or severe encephalopathy. Amplitude integrated electroencephalogram was used as an adjunct to clinical decision making. From July 2006 to April 2007 TH was initiated only at level 3 centers and thereafter passive cooling was started at the referring centre and continued actively by the neonatal transport team, using gel packs, en-route to level 3 centers. TH was continued for 72 h. Of 169 eligible newborns, 123 (73%) were cooled, only one of 15 (7%) prior to 2007 vs 122 of 154 (79%) after. Ninety-three of 123 (76%) were outborn and 77 of 93 (83%) were cooled on transport. 116 of 123 (94%) had at least one perinatal event (70% had acidosis, 68% had Apgar ≤5 at 10', and 81% required resuscitation at 10'). All had abnormal neurologic exam and 20 of 123 (16%) died. All surviving newborns are being followed for neurodevelopmental outcomes. Despite the vast catchment area and transport time, sometimes >6 h, the initiation of TH for newborns with HIE prior and during transport could be achieved in a timely manner in >80% of cases. Recognition and timely referral is crucial in reducing risk of mortality and morbidity in these newborns.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| 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 source (direct Gemma or distilled Codex), 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".