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9 - Hypothermia during patient transport

from Section 2 - Clinical neural rescue

Published online by Cambridge University Press:  05 March 2013

By
Susan E. Jacobs
Edited by
A. David Edwards ,
Denis V. Azzopardi  and
Alistair J. Gunn
A. David Edwards
Affiliation:
Institute of Reproductive and Developmental Biology, Imperial College, London
Denis V. Azzopardi
Affiliation:
Institute of Reproductive and Developmental Biology, Imperial College, London
Alistair J. Gunn
Affiliation:
School of Medical Sciences, University of Auckland
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Summary

Introduction

Therapeutic hypothermia is part of standard care for term and near-term newborn infants with moderate-to-severe hypoxic–ischaemic encephalopathy (HIE) in neonatal intensive care units (NICU) with the expertise, equipment, education, training and protocols to provide this treatment (cooling treatment centres) [1–5]. The safe implementation of hypothermia treatment is being monitored and supported by data from international newborn encephalopathy registries [6–8].

For maximal neuroprotective benefit, therapeutic hypothermia must commence as soon as possible after the hypoxic-ischaemic insult and within the 6-hour “window of opportunity”, before the onset of seizures and secondary neuronal injury [9,10]. Neuroprotective effect rapidly declines with delayed initiation of hypothermia treatment [9,11].

Randomized controlled trials (RCT) in term newborn infants with HIE assumed that the insult occurred at the time of birth and initiated hypothermia by 6 hours of age [6,12–17]. Standard thermoregulatory management was maintained until infants were assessed for eligibility, informed parental consent was obtained and randomization occurred; consequently hypothermia treatment was delayed until 4 to 5 hours postnatal age.

Type
Chapter
Information
Neonatal Neural Rescue
A Clinical Guide
 , pp. 95 - 106
Publisher: Cambridge University Press
Print publication year: 2013

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