Nationwide variability in sedation, analgesia, and developmental care practices during neonatal therapeutic hypothermia: A French national survey

Analgesia, sedation and developmental care are key components of supportive management for newborns with hypoxic–ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). However, evidence-based recommendations remain limited, and practices may vary substantially between centers. We aimed to describe current practices in analgesia, sedation, and developmental care during TH across French neonatal intensive care units (NICUs). We conducted a nationwide cross-sectional survey using a standardized electronic questionnaire distributed to all NICUs performing TH in France. Each center provided a single consolidated response. Descriptive statistics were used. Fifty-one of 63 eligible NICUs responded (80%), including 33 university and 18 general hospitals. Formal developmental care programs were available in 88% of centers. Routine endotracheal intubation during TH was reported by 71%. The most frequently used medications were midazolam (94%), sufentanil (88%), morphine (84%), and paracetamol (82%). Analgesia–sedation regimens and dosing strategies varied markedly across centers. Most NICUs (75%) expressed interest in developing protocols allowing TH without routine intubation. Conclusions : Substantial inter-center variability exists in analgesia, sedation, and developmental care practices during neonatal TH. These findings support the need for standardized, evidence-based protocols to optimize neonatal comfort and reduce practice heterogeneity. What is Known: • Therapeutic hypothermia is the standard neuroprotective treatment for moderate-to-severe neonatal hypoxic-ischemic encephalopathy .• Analgesia, sedation, and supportive care during therapeutic hypothermia are widely used, but evidence-based recommendations remain limited . What is New: • This first nationwide French survey demonstrates marked inter-center variability in analgesia, sedation, developmental care, and routine intubation practices during neonatal therapeutic hypothermia .• These findings highlight the need for standardized, pharmacologically informed protocols during therapeutic hypothermia, prioritizing medications with more predictable metabolism and clearer pharmacokinetic-based dosing strategies .