Hypoxic Brain Injury & Elective Hypothermia... Who's doing it? - page 2

Hi all, We're getting ready to start trialing a new whole-body cooling system for hypoxic-brain injury term infants. I need to start researching protocols, etc for our new program. Is anyone using... Read More

  1. by   stillpressingon
    What is this, the hypoxic brain injury? Sounds like not enough O2 @ birth, but how does hypothermia help with it?
  2. by   SteveNNP
    It decreases the brain's metabolism, and is thought to minimize the release of metabolites/oxidizing substances which damage brain tissue. Hypoxic brain injury is the result of the brain being starved of oxygen ante/intrapartum, and immediately postpartum during resuscitation.
  3. by   preemieRNkate
    We sent a baby out for head cooling yesterday, but we're getting her back today because she didn't qualify (abnormal EEG). Her apgars were 0, 0, 2. No HR for ~9 minutes, no spontaneous respirations at all, cord pH 6.2, post-resuscitative pH 6.7 I believe. YUCK!! FT baby (40+ weeks, mom felt no movement all weekend, but apparently thought it was normal, went to the OB, poor BPP, sent over for emergent c/s), I think they're the worst, preemies aren't supposed to be born yet, so when they're sick it's kind of expected but FT babies are supposed to be healthy and cute, not on death's door!

    I can only recall one baby that went for head cooling and came back to us after, he did not act like a normal newborn AT ALL. But who knows, I guess it depends on the babe.
  4. by   wee one rn
    The unit that I work in was part of a cooling blanket study and we now use it on kiddos that meet the criteria. I haven't seen it used very often, but there have been a couple kiddos that did quite well after very low apgars and low cord pHs. The little one that I took care of was cooled and then within a week was D/C'd home with a completely normal assessment. I am curious about how she will be once she gets older, but upon D/C, she was a 'normal' newborn. :spin:
  5. by   twinkletoes53
    [quote=SteveRN21;1955140]Hi all,

    We're getting ready to start trialing a new whole-body cooling system for hypoxic-brain injury term infants. I need to start researching protocols, etc for our new program. Is anyone using a system like this? Any info would be appreciated.


    Arkansas Children's Hospital was one of the hospitals that participated in the clinical trials on head cooling. This treatment has now been approved by the FDA. We obtain consent and enroll infants who meet the criteria for head cooling. It must be started within 6 hours of birth, and continues for 72 hours.
    Last edit by twinkletoes53 on Jan 24, '07 : Reason: Clarification/Removing reference to clinical instructor
  6. by   justjenny
    Quote from SteveRN21
    Hi all,

    We're getting ready to start trialing a new whole-body cooling system for hypoxic-brain injury term infants. I need to start researching protocols, etc for our new program. Is anyone using a system like this? Any info would be appreciated.

    Stevern21
    We just transferred a baby to U of M (Ann Arbor, MI.) for this. Why don't you contact some of the hospitals that already utilize the cooling system for information on policies, etc. ???? Does the manufacturer/rep offer any literature, resources, etc.???
    Good luck! Please post more as you learn to teach the rest of us!

    Jenny
  7. by   wensday
    Hi, we've just finished the TOBY trial and will be having it as our policy.
    http://www.npeu.ox.ac.uk/Toby/
    I work at Liverpool Womens Hospital, UK.
  8. by   Mags4711
    Quote from justjenny
    We just transferred a baby to U of M (Ann Arbor, MI.) for this. Why don't you contact some of the hospitals that already utilize the cooling system for information on policies, etc. ???? Does the manufacturer/rep offer any literature, resources, etc.???
    Good luck! Please post more as you learn to teach the rest of us!

    Jenny

    That's where I am. We trialed the Cool Cap way back when and have been doing body cooling for some time as well. Steve, does your hospital participate in the Vermont Oxford Network? They have a wealth of information about it.

    PM me and I'll see what protocols I can dig up (unless they are study protocols, then my hands are kind of tied).

    Sadlady, I'm so sorry to hear of your ex's issues. I worked Trauma for a few years prior to coming to the NICU and I have to be honest, no I haven't. But that does NOT mean that someone else's experiences are the same as mine. I agree, you'd be best to go to the Neuro and/or Trauma/Surgical forums and ask your question there. Those nurses have a wealth of experience in cases like yours.
  9. by   prmenrs
    Quote from stillpressingon
    What is this, the hypoxic brain injury? Sounds like not enough O2 @ birth, but how does hypothermia help with it?

    Often, the hypoxia occurs before birth.
  10. by   Kalico
    Quote from SteveRN21
    On an interesting note, I had a pt last week that we transferred out to another facility that does elective hypothermia. He had been born after being found to have a HR in the 50's at mom's latest US appt. The doc wheeled mom as fast as he could to the OR, intubated and sectioned her, and we got the kid with apgars of 0-1-2-4. He was intubated and brought back to the unit, went into Vtach with a pulse, got Adenocard, converted, and got lines and a quick ride to another facility. (He was a 37 wkr) They paralyzed/sedated him, cooled him to 33c for 72 hours and warmed him up by 1c/hr until normal body temp. He came off the vent, was backtransported, and just went home, a normal-acting newborn. It was quite interesting! I'm wondering what his developmental outcomes will be, but from what I've been reading, they have had much success with this type program.
    Do you still need info on protocols?? I work at a hospital in NC that is currently performing elective hypothermia for asphyxiated infants. Please let me know if you are in need of any info.
  11. by   SteveNNP
    I'll keep you posted. Right now one of our neos, our CUE and myself are the only ones pushing for this. We have 3 neos, one of which is our medical director. He says he's not ready for this, but we're itching to get started. I'll come find y'all that have the protocols as soon as we get going! We are in the V/O network, so maybe my neo can dig up some info there....
  12. by   MrBabyNurse
    Steve,

    The trials and studies have been done, somewhere, sometime. My NICU opted to implement the body cooling protocol. Certain criteria have to be met. Infant must have hypoxic-ischemic event. Must be >35 week. Must be able to implement body cooling within 6 hrs of birth, no major congenital anomalies, no severe IUGR <1800 g, no infants in extremis with no additional intensive therapies being offered by attending.

    Attending/NNP should assess for either #1 or #2 Clinical & Biochemical Criteria

    1. If blood gas is available and Cord pH or first postnatal blood gas within 1 hr must be <7.0 OR base deficit on cord gas within 1 hr >16mEq/L.

    2. If blood gas is not available or pH 7.01-7.15 OR Base deficit 10-15.9mEq/L...infant should have acute perinatal event and either Apgar of <5 at 10 minutes OR continued need for ventilation initiated at birth and continued for at least 10 minutes.

    Step 2 is the neuro exam. Pt must have signs of encephalopathy documented by the attending/NNP.

    Body cooling is for 72hrs. Pt is cooled to 33.5 C, monitored and controlled by the esophageal probe. Warming up takes 6 hrs, warming by .5 C q1hr to 36.5 C.

    Of the 3 pts we have done this with, 2 were in such bad shape when they came to us that they died, but the most recent one did very well and could be considered a healthy newborn.

    I am in NC..would be happy to share more if you need more information.

    Good luck,
    Brian
  13. by   SteveNNP
    Thanks man, I'll keep in touch!

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