In this section
Definition of terms
Criteria for therapeutic hypothermia
Nursing Assessment and Management
Family centred care
Neonatal asphyxia is a major health issue globally. In developed countries asphyxia affects 3-5 per 1000 live births. Subsequent development of moderate to severe hypoxic-ischaemic encephalopathy (HIE) occurs in 0.5- 1 per 1000 live births, with up to 60% of these babies dying during the neonatal period and 25% of survivors having major long term neurodevelopmental problems.
Many experimental animal models and systematic reviews of randomised controlled trials have shown that both whole-body hypothermia and selective head cooling has a neuroprotective effect. It modifies the cells programmed for apoptosis leading to their survival.
Hypothermia may also protect neurons by reducing cerebral metabolic rate. Therapeutic hypothermia aims to lower the temperature of the vulnerable deep brain structures to 33-34°C. Hypothermia is not without risk and thus it is important to manage the patient safely during induction and maintenance of hypothermia and during the rewarming process.
The aim of this guideline is to describe the management of a patient undergoing therapeutic hypothermia in the NICU
hyper/hypothermia system: Provides a means for regulating patient temperature by supplying temperature controlled water via a blanket placed under the patient.
6. Moderate to severely abnormal background activity on amplitude-integrated EEG i.e. discontinuous, burst suppression or low voltage +/-
7. At the neonatal consultant’s discretion to commence therapeutic cooling
Complications are more likely to occur or worsen with lower temperatures. Avoid overcooling the patient.
Explain to family the reasoning for using hypothermia and the expected length of treatment. Explain to family that their baby will feel cold for the duration of the treatment and reassure them that their baby will be kept comfortable during the treatment. Encourage bonding by allowing parents to touch their baby, do nappy changes etc.
How to use Medi-Therm III hyper/hypothermia system
The evidence table for this guideline can be found here.
Please remember to read the
The development of this nursing guideline was coordinated by Emily Blyth, Clinical Support Nurse, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated October 2019.