hypothermia therapy

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    Smaller hospital here, we ship out our really sick or really early babies but we recently had a case that I was wondering if the babe could have been treated with hypothermia therapy but wasn't. I understand the theory behind it, but what about if the hypoxic injury is thought to be more chronic (key word is thought, not known). Case was a classic "ugly-as-it-gets" category 3 strip walked in off the streets. Crash section quickly thereafter and pulled out a severe IUGR term kiddo who needed lots of resus. NICU team was called in. Severe acidosis. vented, bicarb, ivs for B/Ps, seizures, the works. Didn't send it for hypothermia. Neonate's theory being that the severe IUGR indicates a more chronic assault. My thoughts are, what would it have hurt to try? Do protocols for hypothermia in your facilities frequently refuse infants with SUSPECTED chronic asphyxia causes (without proof)? Can these babies be helped by hypothermia?
    thanks!
  2. 8 Comments so far...

  3. 0
    http://www.unchealthcare.org/site/Nu...ls/pedscooling

    I hope the link works, but this is the criteria/ algorithm we use. There are a lot of things to consider.
  4. 0
    Sounds like the newborn would have been a good candidate. I would like to see my area doing more of this, the results in studies I've reviewed seem promising.access to this is our biggest hurdle, have to fly then off out of state and our local CCN doesn't play well with others.this algorithm is very helpful, I'll have to get the one they use at the children's hospital and post it, maybe it will lead to more referrals.
  5. 0
    Was the infant over 1800 grams? I saw this on the protocol NICUgal posted. My NICU doesn't cool so I confirmed this with a close friend that works I'm the unit where we transferred that their NICU has the same standard.


    Sent from my iPhone using allnurses
  6. 1
    Seizures don't automatically mean that the baby took a hypoxic hit in utero or shortly after birth.

    Was the baby symmetric or asymetric IUGR? That makes a difference because one involves brain development and the other does not. What was mom's history? Drugs? Was mom's placenta OK? Was there a nuchal cord or meconium?

    If it was drugs and the baby got narcan (which is a terrible thing to do but we see outlying hospitals do this often enough) this can cause seizures.

    If a baby has low blood sugar which is fairly common in IUGR, that can cause seizure like activity. What were the electrolytes?

    There are so many questions unanswered here that would determine if a baby could be cooled or not.

    If it is a "chronic asphyxia" and IUGR my first thought is placental insufficiency and then my second question is why.

    Not everything neuro can be cooled unfortunately.
    NicuGal likes this.
  7. 0
    Quote from TiffyRN
    Was the infant over 1800 grams? I saw this on the protocol NICUgal posted. My NICU doesn't cool so I confirmed this with a close friend that works I'm the unit where we transferred that their NICU has the same standard.


    Sent from my iPhone using allnurses
    I was going to ask about the size of the IUGR also. We (and I reckon most units) have a minimum weight guideline for consideration of cooling.
  8. 0
    We do >36 weeks, <6 hours of age, and I believe >1800 grams. Our algorithm also lists a major perinatal event as a criterion (cord prolapse, abruption, etc.). We do have a witnessed seizure by a reliable observer as a "slam dunk," but I do agree that there are some babies who seem like they might be a case for cooling that are not.
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    What did cord gases look like? For us criteria include weight, cord gases, <6hr, gestational age and + CFM monitoring strip.
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    40 weeks by good dates. didn't get cord gases (i know i know.it wasn't me). first sugar WNL. just barely over 1800. asymetrical IUGR. no mec. apparently normal fluid volume. no cord issues seen. in hindsight- tox negative. placenta report was abnormal. villitis, chorioamnionitis, something about extra vascular fluid, cellular obliteration (sp?), small placenta, abruption likely, it just went on and on in the report. poor kiddo. CCN won't share as to how the babe is doing, unfortunately. I'd love to know. I'd love even more to know how this kid scores 1 year out.


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