Whole Body Cooling for Infants with Hypoxic-Ischemic Encephalopathy

Mosalli R. Whole body cooling for infants with hypoxic-ischemic encephalopathy. J Clin Neonatol. 2012 Apr;1(2):101-6. doi: 10.4103/2249-4847.96777. PMID: 24027701; PMCID: PMC3743149.

Background
Hypoxic-ischemic injury remains an important cause of perinatally acquired brain injury in full-term infants. The best predictor of mortality and long-term outcome following perinatal injury is the presence of neonatal encephalopathy. If moderate encephalopathy is present, the risk of death is less than 10% and as many as one-third of the survivors have physical disabilities. With severe encephalopathy, mortality is higher (as much as 60%) and many, if not all, survivors are handicapped. The benefit of induced hypothermia in post-asphyxia encephalopathy has been proven in high-quality randomized controlled trials to be safe. In addition, it reduces the incidence of death and disability at 18-22 months of age. The current evidence does not support cooling of infants with mild hypoxic-ischemic encephalopathy (HIE) or those born before 35 weeks.

Purpose
To promote and facilitate standardization and consistency of practice, using the most updated evidence-based information
To provide direction to clinicians regarding therapeutic hypothermia for neonates of 36 weeks of gestation or greater with HIE.

Standard of Care
The aim is to cool infants with moderate or severe HIE within 6 h of birth to a body temperature between 33.5°C and 34.5°C and maintain this degree of cooling without interruption for 72 h.
This would be followed by slow re-warming over at least 4 h at a rate of 0.5°C per hour until their rectal temperature reaches the desired range (36.5-37°C).

Equipment/Supplies
– Cold packs or other alternative cooling devices
– Rectal temperature probe (thermometer)
– Temperature cable (appropriate for monitor)
– Cerebral function monitor (CFM) if available
– Cardio-respiratory monitor

Eligibility Criteria for Infant Cooling
Infants of gestational age greater than or equal to 36 weeks must meet both physiological and neurological criteria .

Disponível Em: <https://pmc.ncbi.nlm.nih.gov/>