Eur J Pediatr. 2025 Oct 13;184(11):681. doi: 10.1007/s00431-025-06510-0.
ABSTRACT
Neonatal hypoxic-ischemic encephalopathy (HIE) is a severe complication of perinatal asphyxia requiring timely and coordinated interventions. While international guidelines address early resuscitation and therapeutic hypothermia, key aspects of severe perinatal asphyxia and HIE management remain undefined, leading to practice variability in France. This study aimed to achieve national expert consensus on the first hour’s perinatal care for infants with perinatal asphyxia or HIE using the Delphi method. A three-round Delphi survey was conducted between April and July 2021, involving 58 French perinatal care experts (neonatologists, pediatricians, midwives) from ten regions. A multidisciplinary team developed the questionnaire based on a literature review and national/international guidelines. Topics included delivery room equipment, resuscitation timelines, hypothermia protocols, and glycemic management. Consensus was defined as ≥ 70% agreement on Likert-scaled items. Of 165 items evaluated, 144 achieved consensus. Key agreements included mandatory delivery room equipment, the time limits after which certain resuscitative interventions were deemed to be delayed in case of severe perinatal asphyxia. Consensus supported passive hypothermia initiation in the delivery room with a target temperature of 35-35.5 °C and parenteral correction of hypoglycemia, with first glucose testing before 30 min of life in case of presumed hypoxic-ischemic encephalopathy. No consensus was reached for sedation, rectal temperature probes, or enteral glucose correction.
CONCLUSIONS: This study highlights the necessity of a standardization in management practices. Consensus was achieved on several practices and terms, underscoring the need for further efforts to standardize care protocols and definitions.
WHAT IS KNOWN: • The management of severe perinatal asphyxia and neonatal presumed hypoxic-ischemic encephalopathy (HIE) follows international guidelines, but certain practices remain center-specific and vary significantly.
WHAT IS NEW: • Consensus was achieved on both the initial organizational framework and practical procedures for the management of HIE in the delivery room and during the early hours of neonatal care.
PMID:41077571 | DOI:10.1007/s00431-025-06510-0
