Breaking down barriers: Overcoming bottlenecks in the health- care system for newborns with hypoxic ischemic encephalopathy

Abstract

Abstract Purpose: To evaluate the practices of neonatologists and pediatricians for neonates with hypoxic-ischemic encephalopathy (HIE) in Jordan to identify gaps in diagnosis, management, and follow-up of HIE, including the availability of long-term follow-up services. This is an important clinical issue to address as HIE is the fourth leading cause of infant mortality in Jordan. Methods: This was a cross-sectional study including 15 neonatologists and 42 pediatricians treating neonates with HIE in Jordan. Data were collected using a custom-designed, self-report questionnaire, consisting of 35 items across four dimensions: participant demographics; indicators used for HIE diagnosis; criteria used to determine HIE severity and HIE management strategy, including therapeutic hypothermia practice; and availability of long-term services for HIE follow-up. Items were answered on a 5-point Likert scale, with anchors measuring the extent to which practices were used: 1, never; 2, seldom; 3, sometimes; 4, frequent; and 5, always. Results: The Apgar score was used by 70% of participants to evaluate neonates’ status at birth and the SARNAT staging score to determine the severity of HIE. Management strategy included the transfer of neonates to intensive care (30%), initiation of therapeutic hypothermia within 6 h post-natal (70%), and continuation of hypothermia for the full recommended 72 h (63.2%). Timely access to brain imaging was not available to all participants. Technology to assess brain activity was insufficient. Conclusion: The development of a bundle for HIE practices would be recommended in Jordan to improve the quality of care for neonates with HIE.