Prognostication in Neonatal Hypoxic Ischemic Encephalopathy; A Qualitative Research Study PDF
By:Lisa Anne Rasmussen
Published on 2018 by
|AbstractBackgroundHypoxic ischemic encephalopathy is the most frequent cause of neonatal encephalopathy, and results in significant morbidity and mortality. From an ethical and clinical standpoint, neurological prognosis is fundamental in the care of neonates with hypoxic ischemic encephalopathy. However, accurately predicting neurodevelopmental outcomes for neonatal hypoxic ischemic encephalopathy is particular difficult, and fraught with challenges. At present, focused research in this area is limited. ObjectivesThis thesis aims to present a review of the current literature on prognosis and the practice of prognostication in neonatal hypoxic ischemic encephalopathy, focusing on the integral challenges posed by this vulnerable group of neonates. Furthermore, this thesis incorporates an original qualitative study that explores physician perspectives about prognostication in neonatal hypoxic ischemic encephalopathy. The main objective of this thesis is to advance the current understanding of the practice of prognostication in neonatal hypoxic ischemic encephalopathy, in hopes of opening up dialogue and encouraging modifications in clinical practice to improve patient care. MethodsThe introduction and background section of this thesis presents a review of the literature on prognosis, prognostication, and neonatal hypoxic ischemic encephalopathy. Focus is placed on selected articles in an attempt to introduce the reader to the subject mater. The research publication included in this thesis is based on a Canadian qualitative study of neonatologists and pediatric neurologists, which focuses on exploring physician perspectives on prognosis and prognostication in neonatal hypoxic ischemic encephalopathy. For the purpose of this thesis, only data pertaining to the practice of prognostication will be presented, though there were other themes explored in the larger research study including uncertainty, communication, and shared-decision-making. ResultsThere are two chapters presenting the results in this thesis. The first consists of a published manuscript that reports on data regarding physician perspectives on prognostication in neonatal hypoxic ischemic encephalopathy, and the second presents unpublished data exploring the challenges of prognostication in neonatal hypoxic ischemic encephalopathy. ConclusionsAlthough this thesis offers some practical changes for the improvement of clinical care in neonatal HIE, its true contribution is to serve as a launching point for further research. Focused research is needed to explore both the parental perspective and, prospectively, the impact of different clinical approaches and styles to prognostication for neonatal hypoxic ischemic encephalopathy. | --
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