{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:59:41Z","timestamp":1778284781264,"version":"3.51.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Therapeutic hypothermia (TH) reduces neonatal mortality and long-term neurodevelopmental impairment in infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) caused by perinatal asphyxia. There is an increasing trend to apply TH in other indications and populations, such as infants with mild HIE or neonates with congenital heart defects (CHD), even though there is little evidence to support or refute this.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this survey was to analyze practice variations with respect to TH use in neonates with CHD and to assess expert opinions on this topic across tertiary neonatal departments in Germany.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods\/Design<\/jats:title><jats:p>A web-based survey was sent to all tertiary neonatal departments in Germany. The questionnaire contained 32 multiple-choice questions. The survey inquired current practices on TH in newborns with CHD and expert opinions on various clinical scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>A total 80 (51.3%) neonatal departments partially completed the survey, and 69 (44.2%) respondents filled out the whole questionnaire. All 80 (100.0%) departments perform TH. TH is offered by 76 (95.0%) respondents to encephalopathic newborns with simple CHD. In infants with critical\/complex CHD, TH is offered after perinatal asphyxial HIE and in newborns with encephalopathy after severe acidosis associated with cardiac complications by 25 (31.3%), or 17 (22.1%) respondents, respectively, whereas a clear majority of centers reject TH in these infants. Unclear effects of TH on any ongoing prostaglandin therapy (57.6 and 52.3%, respectively), an increased risk for adverse reactions during TH (51.6 and 52.3%, respectively) and lack of evidence (33.3 and 53.8%, respectively) are the most frequently cited reasons for not performing TH in these infants. The majority of experts from neonatal departments providing comprehensive care for neonates with severe CHD support the initiation of TH in encephalopathic neonates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The considerable heterogeneity in the use of TH in neonates with CHD emphasizes the need for further research to optimize treatment strategies for these patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.1004086","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T06:48:30Z","timestamp":1664952510000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Therapeutic hypothermia for encephalopathic newborns with congenital heart defect: A cross-sectional survey on current practices and opinions in Germany"],"prefix":"10.3389","volume":"10","author":[{"given":"Vinzenz","family":"Boos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Berger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/S0002-9378(97)70080-2","article-title":"Threshold of metabolic acidosis associated with newborn complications","volume":"177","author":"Low","year":"1997","journal-title":"Am J Obstet Gynecol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"CD003311","DOI":"10.1002\/14651858.CD003311.pub3","article-title":"Cooling for newborns with hypoxic ischaemic encephalopathy","volume":"2013","author":"Jacobs","year":"2013","journal-title":"Cochrane Database Syst Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"142","DOI":"10.3389\/fped.2019.00142","article-title":"Neonatal encephalopathy: need for recognition of multiple etiologies for optimal management","volume":"7","author":"Aslam","year":"2019","journal-title":"Front Pediatr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"F515","DOI":"10.1136\/archdischild-2018-316040","article-title":"Therapeutic hypothermia initiated within 6 h of birth is associated with reduced brain injury on MR biomarkers in mild hypoxic-ischaemic encephalopathy: a non-randomised cohort study","volume":"104","author":"Montaldo","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"key":"B5","doi-asserted-by":"publisher","first-page":"53","DOI":"10.3109\/14767058.2011.607617","article-title":"Brain cooling and eligible newborns: should we extend the indications?","volume":"24","author":"Gancia","year":"2011","journal-title":"J Matern Fetal Neonatal Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.resuscitation.2018.02.022","article-title":"Post-arrest therapeutic hypothermia in pediatric patients with congenital heart disease","volume":"126","author":"Cheng","year":"2018","journal-title":"Resuscitation."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.1111\/apa.13983","article-title":"Zanelli SA. Neonatal therapeutic hypothermia outside of standard guidelines: a survey of US neonatologists","volume":"106","author":"Burnsed","year":"2017","journal-title":"Acta Paediatr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.pediatrneurol.2015.07.012","article-title":"Subacute hypoxia-ischemia and the timing of injury in treatment with therapeutic hypothermia","volume":"53","author":"Kasdorf","year":"2015","journal-title":"Pediatr Neurol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"04030","DOI":"10.7189\/jogh.12.04030","article-title":"Therapeutic hypothermia in neonatal hypoxic encephalopathy: a systematic review and meta-analysis","volume":"12","author":"Mathew","year":"2022","journal-title":"J Glob Health."},{"key":"B10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1055\/s-0033-1361104","article-title":"Behandlung der neonatalen Asphyxie unter besonderer Ber\u00fccksichtigung der therapeutischen Hypothermie [Treatment of neonatal asphyxia with a special focus on therapeutic hypothermia]","volume":"226","author":"Flemmer","year":"2014","journal-title":"Klin Padiatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1038\/s41372-019-0474-y","article-title":"Delivery room asphyxia in neonates with ductal-dependent congenital heart disease: a retrospective cohort study","volume":"39","author":"Boos","year":"2019","journal-title":"J Perinatol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/PCC.0000000000001878","article-title":"Therapeutic hypothermia after perinatal asphyxia in infants with severe, ductal-dependent congenital heart disease","volume":"20","author":"Boos","year":"2019","journal-title":"Pediatr Crit Care Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.amjcard.2012.11.029","article-title":"Specialized delivery room planning for fetuses with critical congenital heart disease","volume":"111","author":"Donofrio","year":"2013","journal-title":"Am J Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1002\/pd.4821","article-title":"Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes","volume":"36","author":"Wolter","year":"2016","journal-title":"Prenat Diagn."},{"key":"B15","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1038\/jp.2011.50","article-title":"The effect of late preterm birth on mortality of infants with major congenital heart defects","volume":"32","author":"Swenson","year":"2012","journal-title":"J Perinatol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3389\/fped.2016.00137","article-title":"Factors influencing neurodevelopment after cardiac surgery during infancy","volume":"4","author":"H\u00f6vels-G\u00fcrich","year":"2016","journal-title":"Front Pediatr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e2021050875","DOI":"10.1542\/peds.2021-050875","article-title":"Cognitive and executive function in congenital heart disease: a meta-analysis","volume":"148","author":"Feldmann","year":"2021","journal-title":"Pediatrics."},{"key":"B18","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1136\/archdischild-2019-317824","article-title":"Neurodevelopmental status and follow-up in preschool children with heart disease in London, UK","volume":"106","author":"Hoskote","year":"2021","journal-title":"Arch Dis Child."},{"key":"B19","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1097\/MOP.0000000000000829","article-title":"Recent advances in our understanding of neurodevelopmental outcomes in congenital heart disease","volume":"31","author":"White","year":"2019","journal-title":"Curr Opin Pediatr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/j.cjca.2022.02.009","article-title":"Neurodevelopment and cognition across the lifespan in patients with single-ventricle physiology: abnormal brain maturation and accumulation of brain injuries","volume":"38","author":"Selvanathan","year":"2022","journal-title":"Can J Cardiol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00246-020-02440-w","article-title":"Antenatal and perioperative mechanisms of global neurological injury in congenital heart disease","volume":"42","author":"Barkhuizen","year":"2021","journal-title":"Pediatr Cardiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.athoracsur.2009.03.030","article-title":"Perioperative stroke in infants undergoing open heart operations for congenital heart disease","volume":"88","author":"Chen","year":"2009","journal-title":"Ann Thorac Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1089\/ther.2011.0016","article-title":"Therapeutic hypothermia in a neonate with perinatal asphyxia and transposition of the great arteries","volume":"1","author":"Mulkey","year":"2011","journal-title":"Ther Hypothermia Temp Manag."},{"key":"B24","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3389\/fped.2020.00068","article-title":"Getting an early start in understanding perinatal asphyxia impact on the cardiovascular system","volume":"8","author":"Popescu","year":"2020","journal-title":"Front Pediatr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"140","DOI":"10.3389\/fped.2018.00140","article-title":"Echocardiographic evaluation of transitional circulation for the neonatologists","volume":"6","author":"Singh","year":"2018","journal-title":"Front Pediatr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"239","DOI":"10.3389\/fped.2020.00239","article-title":"Management of multi organ dysfunction in neonatal encephalopathy","volume":"8","author":"O'Dea","year":"2020","journal-title":"Front Pediatr."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.1080\/14767058.2017.1344633","article-title":"Effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia\u2014a randomized controlled trial","volume":"31","author":"Rakesh","year":"2018","journal-title":"J Matern Fetal Neonatal Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"F388","DOI":"10.1136\/archdischild-2017-313320","article-title":"Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK","volume":"103","author":"Oliveira","year":"2018","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.3389\/fphar.2019.01221","article-title":"Comparative efficacy and safety of neuroprotective therapies for neonates with hypoxic ischemic encephalopathy: a network meta-analysis","volume":"10","author":"Lee","year":"2019","journal-title":"Front Pharmacol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"277","DOI":"10.4103\/1673-5374.317963","article-title":"Challenges in developing therapeutic strategies for mild neonatal encephalopathy","volume":"17","author":"McDouall","year":"2022","journal-title":"Neural Regen Res."},{"key":"B31","unstructured":"2018"},{"key":"B32","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1097\/MCC.0000000000000943","article-title":"Temperature control after cardiac arrest: friend or foe","volume":"28","author":"Nolan","year":"2022","journal-title":"Curr Opin Crit Care."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.1004086\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T06:48:33Z","timestamp":1664952513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.1004086\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,5]]},"references-count":32,"alternative-id":["10.3389\/fped.2022.1004086"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.1004086","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,5]]},"article-number":"1004086"}}