Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cb9f654ff-h4f6x Total loading time: 0 Render date: 2025-08-13T06:07:31.185Z Has data issue: false hasContentIssue false

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
Get access

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.

Information

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Blackmon, LR, Stark, ARand the Committee on Fetus and Newborn AAP. Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy. Pediatrics 2006;117:942–8.CrossRefGoogle Scholar
British Association of Perinatal Medicine. Position statement on therapeutic cooling for neonatal encephalopathy, British Association of Perinatal Medicine. 2010. Statement on Therapeutic Cooling for Neonatal Encephalopathy July 2010.pdf [cited August 2010] Available from: .
Higgins, RD, Raju, T, Edwards, AD, et al. Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop. J Pediatr 2011;159:851–8 e1.CrossRefGoogle Scholar
Hoehn, T, Hansmann, G, Bührer, C, et al. Therapeutic hypothermia in neonates. Review of current clinical data, ILCOR recommendations and suggestions for implementation in neonatal intensive care units. Resuscitation 2008;78:7–12.CrossRefGoogle ScholarPubMed
National Health Service. Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury. National Institute for Health and Clinical Excellence, Interventional Procedure Guidance 347. [May 26 2010] Available from: .
Azzopardi, DV, Strohm, B, Edwards, AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009;361:1349–58.CrossRefGoogle ScholarPubMed
Kendall, GS, Kapetanakis, A, Ratnavel, N, et al. Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child 2010;95:F408–12.CrossRefGoogle ScholarPubMed
Strohm, B, Azzopardi, D. Temperature control during therapeutic moderate whole-body hypothermia for neonatal encephalopathy. Arch Disease Child Fetal Neonatal Ed 2010;95:F373–5.CrossRefGoogle ScholarPubMed
Gunn, AJ. Cerebral hypothermia for prevention of brain injury following perinatal asphyxia. Curr Opin Pediatr 2000;12:111–5.CrossRefGoogle ScholarPubMed
Haaland, K, Loberg, EM, Steen, PA, Thoresen, M. Posthypoxic hypothermia in newborn piglets. Pediatr Res 1997;41:505–12.CrossRefGoogle ScholarPubMed
Iwata, O, Iwata, S, Thornton, JS, et al. “Therapeutic time window” duration decreases with increasing severity of cerebral hypoxia-ischaemia under normothermia and delayed hypothermia in newborn piglets. Brain Res 2007;1154:173–80.CrossRef
Eicher, DJ, Wagner, CL, Katikaneni, LP, et al. Moderate hypothermia in neonatal encephalopathy: safety outcomes. Pediatr Neurol 2005;32:18–24.CrossRefGoogle ScholarPubMed
Gluckman, PD, Wyatt, JS, Azzopardi, D, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005;365:663–70.CrossRefGoogle ScholarPubMed
Jacobs, SE, Morley, CJ, Inder, TE, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011;165: 692–700.CrossRefGoogle ScholarPubMed
Shankaran, S, Laptook, AR, Ehrenkranz, RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005;353: 1574–84.CrossRefGoogle ScholarPubMed
Simbruner, G, Mittal, R, Rohlmann, F, Muche, R. Systemic hypothermia in neonates with hypoxic-ischemic-encephalopathy: Efficacy outcomes of neo.nEURO.network RCT. Pediatrics 2010;126:e771–8.CrossRefGoogle Scholar
Zhou, WH, Cheng, GQ, Shao, XM, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr 2010;157:367–72.CrossRefGoogle Scholar
Davidson, S, Jacobs, S, Stewart, M. ‘Birth asphyxia’: the NETS Victoria perspective. Canberra: 5th Annual Congress of the Perinatal Society of Australia and New Zealand; 2001.
Papile, LA. Systemic hypothermia – a “cool” therapy for neonatal hypoxic-ischemic encephalopathy. N Engl J Med 2005;353:1619–20.CrossRefGoogle ScholarPubMed
Robertson, NJ, Kendall, GS, Thayyil, S. Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy. Semin Fetal Neonatal Med 2010;15:276–86.CrossRefGoogle ScholarPubMed
Gray, J, Geva, A, Zheng, Z, Zupancic, JA. CoolSim: using industrial modeling techniques to examine the impact of selective head cooling in a model of perinatal regionalization. Pediatrics 2008;121:28–36.CrossRefGoogle Scholar
Kattwinkel, J, Cook, LJ, Nowacek, G, et al. Regionalized perinatal education. Semin Neonatol 2004;9:155–65.CrossRefGoogle ScholarPubMed
Zanelli, SA, Naylor, M, Dobbins, N, et al. Implementation of a ‘Hypothermia for HIE’ program: 2-year experience in a single NICU. J Perinatol 2007;28:171–5.CrossRefGoogle Scholar
Fairchild, K, Sokora, D, Scott, J, Zanelli, S. Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU. J Perinatol 2010;30:324–9.CrossRefGoogle Scholar
Anderson, ME, Longhofer, TA, Phillips, W, McRay, DE. Passive cooling to initiate hypothermia for transported encephalopathic newborns. J Perinatol 2007;27:592–3.CrossRefGoogle ScholarPubMed
Hallberg, B, Olson, L, Bartocci, M, Edqvist, I, Blennow, M. Passive induction of hypothermia during transport of asphyxiated infants: a risk of excessive cooling. Acta Paediatr 2009;98:942–6.CrossRefGoogle ScholarPubMed
Thoresen, M. Supportive care during neuroprotective hypothermia in the term newborn: adverse effects and their prevention. Clin Perinatol 2008;35:749–63.CrossRefGoogle ScholarPubMed
Wyatt, JS, Gluckman, PD, Liu, PY, et al. Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics 2007;119:912–21.CrossRefGoogle ScholarPubMed
Burnard, ED, Cross, KW. Rectal temperature in the newborn after birth asphyxia. BMJ 1958;2:1197–9.CrossRefGoogle ScholarPubMed
Robertson, NJ, Nakakeeto, M, Hagmann, C, et al. Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial. Lancet 2008;372:801–3.CrossRefGoogle ScholarPubMed
Dahm, LS, James, LS. Newborn temperature and calculated heat loss in the delivery room. Pediatrics 1972;49:504–13.Google ScholarPubMed
Eicher, DJ, Wagner, CL, Katikaneni, LP, et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005;32:11–7.CrossRefGoogle ScholarPubMed
Horn, AR, Woods, DL, Thompson, C, Eis, I, Kroon, M. Selective cerebral hypothermia for post-hypoxic neuroprotection in neonates using a solid ice cap. S Afr Med J 2006;96:976–81.Google ScholarPubMed
Horn, A, Thompson, C, Woods, D, et al. Induced hypothermia for infants with hypoxic-ischemic encephalopathy using a servo-controlled fan: an exploratory pilot study. Pediatrics 2009;123:e1090–8.CrossRefGoogle ScholarPubMed
National Perinatal Epidemiology Unit. UK TOBY cooling register, National Perinatal Epidemiology Unit, University of Oxford. [Accessed August 2010] Available from: .
Hoque, N, Chakkarapani, E, Liu, X, Thoresen, M. A comparison of cooling methods used in therapeutic hypothermia for perinatal asphyxia. Pediatrics 2010;126:e124–30.CrossRefGoogle ScholarPubMed
Hobson, A, Sussman, C, Knight, J, et al. Active cooling during transport of neonates with hypoxic-ischemic encephalopathy. Air Med J 2011;30:197–200.CrossRefGoogle ScholarPubMed
Johnston, ED, Becher, JC, Mitchell, AP, Stenson, BJ. Provision of servo-controlled cooling during neonatal transport. Arch Dis Child Fetal Neonatal Ed 2012;97:F367–7.CrossRefGoogle ScholarPubMed
O’Reilly, KM, Tooley, J, Winterbottom, S. Therapeutic hypothermia during neonatal transport. Acta Paediatr 2011;100:1084–6; discussion e49.CrossRefGoogle ScholarPubMed
Iwata, S, Iwata, O, Olson, L, et al. Therapeutic hypothermia can be induced and maintained using either commercial water bottles or a “phase changing material” mattress in a newborn piglet model. Arch Dis Child 2009;94:387–91.CrossRefGoogle Scholar
Thayyil, S, Guhan, AB, Marlow, N, et al. Whole body cooling using phase changing material in neonatal encephalopathy: a pilot randomised controlled trial. EPAS 43506. 2010.
Azzopardi, D, Brocklehurst, P, Edwards, D, et al. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008;8:17.CrossRefGoogle ScholarPubMed
Azzopardi, D, Strohm, B, Edwards, AD, et al. Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed 2009;94:F260–4.CrossRefGoogle ScholarPubMed
New South Wales Department of Health. Whole body cooling – neonates suspected moderate or severe hypoxic ischaemic encephalopathy (HIE). Policy Directive 2010_006. [January 22, 2010] Available from: .
Landry, MA, Doyle, LW, Lee, K, Jacobs, SE. Axillary temperature measurement during hypothermia treatment for neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2012 [Epub ahead of print].
Barks, JD. Technical aspects of starting a neonatal cooling program. Clin Perinatol 2008;35:765–75.CrossRefGoogle ScholarPubMed
Gunn, AJ, Gluckman, PD, Gunn, TR. Selective head cooling in newborn infants after perinatal asphyxia: a safety study. Pediatrics 1998;102:885–92.CrossRefGoogle ScholarPubMed
Thoresen, M. Cooling the newborn after asphyxia – physiological and experimental background and its clinical use. Semin Neonatol 2000;5:61–73.CrossRefGoogle ScholarPubMed
Groenendaal, F, Brouwer, AJ. Clinical aspects of induced hypothermia in full term neonates with perinatal asphyxia. Early Hum Dev 2009;85:73–6.CrossRefGoogle ScholarPubMed
Finer, NN, Robertson, CM, Richards, RT, Pinnell, LE, Peters, KL. Hypoxic-ischemic encephalopathy in term neonates: Perinatal factors and outcome. J Pediatr 1981;98:112–7.CrossRefGoogle ScholarPubMed
Sarnat, HB, Sarnat, MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976;33: 696–705.CrossRefGoogle ScholarPubMed

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×