Objective:

To characterize respiratory management strategies in neonates with moderate to severe HIE undergoing therapeutic hypothermia and assess the association between the mode of respiratory support and differences in oxygen exposure and CO2 instability.

Approach:

• Study Design: Retrospective registry-based analysis using data from the German Hypothermia Registry, including term and near-term neonates with moderate or severe HIE treated with whole-body TH.
• Data Collection: Collected demographics, clinical characteristics, and details on respiratory support from 429 neonates treated in 80 NICUs across Germany.

Key Findings:

• Respiratory management during TH is insufficiently standardized.
• Hypocapnia and hypercapnia are associated with adverse neurological outcomes in neonates with HIE.
• Real-world data on oxygen exposure in cooled neonates are scarce.

Interpretation:

The study highlights the need for standardized respiratory management protocols during therapeutic hypothermia to mitigate risks associated with CO2 fluctuations and oxygen exposure.

Limitations:

• The study is based on retrospective data, which may introduce biases.
• Real-world data on oxygen exposure in cooled neonates are scarce.

Conclusion:

Optimal respiratory management strategies during therapeutic hypothermia in neonates with HIE remain to be defined.