Nebraska registry to help newborns at risk of neonatal brain injury

by Karen Burbach
February 20, 2018

Image with file name: Eric_Peeples_Neonatology_2016.jpg

Eric Peeples, M.D., wants to better understand how to identify and treat newborns at risk for neonatal brain injury.

To do that, he and Ann Anderson Berry, M.D., Ph.D., neonatal medical director of the Nebraska Perinatal Quality Improvement Collaborative (NPQIC), are working with Peggy Brown, D.N.P., a quality expert in the collaborative, to develop the Neonatal Encephalopathy Registry.

The goal of the registry is to gather data to unlock clues that could lead to improved detection and treatment of infants with neonatal encephalopathy - a type of brain injury occurring at or around the time of birth.

Drs. Peeples and Anderson Berry are faculty members at the University of Nebraska Medical Center Division of Newborn Medicine and neonatologists at Children’s Hospital & Medical Center and Nebraska Medicine. Dr. Anderson Berry is medical director of the Neonatal Intensive Care Unit at Nebraska Medicine.

"We want a global perspective," Dr. Peeples said. "If we can improve the outcomes of these babies, we could potentially better help families, improve quality of life and decrease the burden on health care systems."

In Nebraska, he said, neonatal encephalopathy may impact up to 200 babies each year.

The lack of oxygen and blood flow to the brain that causes neonatal encephalopathy may occur from blood loss around the time of delivery, umbilical cord compression, or decreased blood flow from the placenta, Dr. Peeples said, and can result in cerebral palsy, or a range of moderate to severe disabilities. "Unfortunately, in the majority of these cases we never identify a cause," he said.

Clinicians know that cooling the brain within six hours after birth can decrease the risk of moderate to severe developmental delay from 80-90 percent without treatment to approximately 50 percent with cooling therapy. "There is a lot of room for improvement on this," Dr. Peeples said.

At cooling treatment centers, of which there are several throughout Omaha and Lincoln, health providers place the newborn on a cooling blanket to keep their temperature at 33.5 degrees Celsius, or 92.3 degrees Fahrenheit, for 72 hours.

"During the cooling, the brain is allowed to rest," Dr. Peeples said. After a slow rewarming period, an MRI is done to help to predict recovery, but "it’s only a piece of the puzzle," he said. "We can’t really know the developmental impact until several months to years of life."

Said Dr. Anderson Berry: "We are excited to partner with NPQIC, COPIC Insurance and delivery hospitals across Nebraska to work to improve delivery of perinatal care and neonatal outcomes. This is why we started NPQIC and I am pleased to launch this important registry."

Launched in December, the registry already has enrolled a handful of newborns. Plans are to continue to expand the registry across all Nebraska hospitals, followed by expansion into nearby states such as Colorado and Iowa.

To enroll, hospital personnel obtain a family’s consent to collect prenatal, delivery, and postnatal data, which ranges from prenatal labs and fetal heart rhythm strips to the infant’s need for anti-seizure medications and results of brain imaging. Developmental data will be obtained through the Nebraska Tracking Infants Progress Statewide program, which follows and identifies delays in development in high-risk infants.

The Neonatal Encephalopathy Registry is funded by a competitive grant from COPIC Insurance, which hopes the data will help improve patient outcomes and decrease medical insurance claims.

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