Cooling

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    Hi there, I have a couple questions regarding cooling of infants with possible hypoxic brain injury, basically,how successful is it? Our NICU is tiny, only 8 beds and we dont really see much of this but are looking at starting, and I would like to know how successful it is, a hospital in another part of the country (South Africa) is having amazing success with cooling post near drownings,with some kids returning to fully functioning as before the incident,do you see this in infants as well, what if the infant was without oxygen for a long period say 20 minutes, as some of the near drownings are? I realize it's difficult to compare a 2 year old who has been submerged in often cold water for long periods to a infant with a birth injury,but I'm still quite interested in the whole concept.
    Thanks in advance
    J
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    Hi, we get kiddos after drowning/near drowning who were resus'd but unfortunately cooling has not made a difference in the outcome. They all showed central destruction.
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    We cool newborns for HIE. I went to a conference on this and it is highly recommended that cooling be done in a center that has 24/7 access to neonatal neurology, continuous EEG monitoring, MRI and capabilities to follow up long term.

    There is a pretty standard but strict policy in place for cooling and outcomes are usually dependent on if the policy was followed or not. A kid that doesn't meet criteria but get's cooled anyways is likely not going to have a good outcome. That being said I can't say what the long term outcomes are since I don't see them long term. Some kids go home doing great (eating/breathing/acting like a newborn) and others are very clearly delayed, require a g-tube, may have seizures or spacticity issues. Some may have more issues that show up later in life. This is why it is recommended to do at a hospital with the ability to follow these kids since it's still in early stages, most kids who were cooled may only be a few years old now so long term (like 10-15 years) is still unknown. I think for the milder cases of HIE cooling probably does help quite a bit, at least more than for those apgars of 0/0/0/0/3 kids.
    NicuGal likes this.
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    In addition to the above, you have to have access to a good pharmacist since their fluids change frequently due to glucose and electrolyte imbalances. We make these kiddos 2:1 for the initial cooling and when we warm. We have had so so success....most have some if not significant neuro issues.
    umcRN likes this.
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    Quote from NicuGal
    In addition to the above, you have to have access to a good pharmacist since their fluids change frequently due to glucose and electrolyte imbalances. We make these kiddos 2:1 for the initial cooling and when we warm. We have had so so success....most have some if not significant neuro issues.
    Oh yes! Dead on with the fluids, ugh they're a nightmare!
    Ours are also usually 2:1 for initial cooling...although not necessarily assigned that way but we have two charge nurses and the second one often stays to help as well as neighbor nurses, it ends up being like 2:1 for that first shift. Warming is not so bad(unless they crash while you're doing it which some do) but because (at my hospital) everything is kept for research purposes it's a LOT of labs and vitals documentation
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    Ours too....it takes one to work on the baby and one to document it seems lol We just had one crash big time while warming...scary stuff! Could not get his labs to even out and then just seized and seized..so sad. We recooled and then had to go to MRI...even more fun. I hate MRI lol I'm glad our fellows stay in house!
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    I am the new director of a community hospital OB dept and just before I came, they put out a new policy allowing us to begin this cooling process on newborns that meet certain criteria, pending transfer to our tertiary care facility. We are a well-baby nursery, mind-you! I'm a bit nervous about this policy, especially considering my staff have had no training.
    Also, a question for you NICU people- Our policy says that we should do continuous rectal temperature monitoring. We don't have anything that will do that at this time. What do you use? Obviously we can't just use a standard rectal thermometer! I've done some brief googling to find something but haven't come up with anything yet.
    Thanks for any info!
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    We use esophageal temperature probes.
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    We had to be trained in cooling with the machine...and we use esophageal temp probes which have to be confirmed by an x-ray. You can turn the warmer off and keep the area cool pending transfer, but I will tell you, you better take this up with your legal department, you should only do this in a controlled enviroment.
    umcRN likes this.
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    Quote from NicuGal
    We had to be trained in cooling with the machine...and we use esophageal temp probes which have to be confirmed by an x-ray. You can turn the warmer off and keep the area cool pending transfer, but I will tell you, you better take this up with your legal department, you should only do this in a controlled enviroment.
    100% agree, this does not sound safe! Now if you know the kid is going to be transferred for cooling then you might not have to take any extreme measures to warm them (don't put them on the warmer, don't swaddle them) but you have to be careful not to over cool too! We use esophageal temp probes which can also be used as rectal temp probes (that's how they are used in the other ICU's in my hospital).

    My other question, as a "well baby" nursery as you say, are you holding onto these kids while they are vented and on pressors? Because most coolers are vented and crash their pressures and I can't see them hanging out in a "well baby" nursery with people who are not trained to care for them.
    DeLanaHarvickWannabe likes this.


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