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

Specialties NICU

Published

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

Specializes in NICU.

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

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 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

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

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Specializes in Neonatal ICU (Cardiothoracic).

Thanks man, I'll keep in touch!

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HELLO STEVERN21, COULD ANYBODY TELL ME THE MEANING OF CUE??? THANK U!:banghead:

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Specializes in Neonatal ICU (Cardiothoracic).

CUE: Clinical Unit Educator.

= RN whose job involves unit staff education.

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The hospital I'm at does the cool cap, but we have yet to have a baby meet all the criteria.

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I know that Phoenix Childrens does the head cooling thing.

I went to a delivery for a "bad strip" turned crash section once we got there. Baby was born with fixed and dilated pupils, barely a heart rate, and was stained with meconium. (no PNC of course) We got the kid intubated and just bagged the crap out of him. He took a few random breaths, but had no response whatsoever. His Apgars were 2, 4, 5. Thankfully he came around and we didn't have to use epi or compressions. I think his cord pH was 6.7.

The neo wanted to transport him, but he was on iNO and HFOV, so we couldn't. He's on low settings vent wise, but his EEG was flat lined with random bursts. I don't think he is going to be much of anything if they get him extubated, but I was told he has a gag. He has a repeat EEG in a couple days.

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Specializes in OT, Palliative, ICU, NICU, Wound Care,.

http://www.nicuniversity.org/downloads/Neonatal_Hypothermia.pdf

http://www.ctc.usyd.edu.au/6registry/PTO367.htm

http://pediatrics.aappublications.org/cgi/content/extract/120/5/1126

These might be of interest to you.

Our unit uses full body cooling for newborns with HIE.

It is not a regular thing but every now and then.

We use a cooling blanket but have difficult as this drops too low and will take too long to rewarm to an acceptable level so we generally nurse with an overhead radiant warmer as well to be safe.

We have been involved in an Aus wide trial called the ICE trial.

There does seem to be some research out there which is easily found using a websearch. Goodluck

Olivereindeer

Royal Hobart Hospital

Australia

NPICU (level III)

RN

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