Cooling Overview

 

Malcolm Battin
Feb
2010
Clinical Guidelines Back Newborn Services Home Page
Indications Complications Application Follow up References

Criticool body cooling

Cooling has been recognised as an effective intervention to decrease adverse neuro-developmental outcomes following perinatal asphyxia 1-5. There are no studies that have performed direct comparison between selective head cooling and whole body cooling and it is generally considered that both techniques provide neuroprotection.

Indications:

It is essential that infants should be adequately resuscitated prior to active cooling.

Severe congenital malformations may be a relative contraindication and would need to be assessed on individual merit. Ano-rectal malformations may mean it is not possible to monitor rectal temperature.

For infants who are moribund and considered likely to die imminently cooling should not be initiated and the focus should be on either further resuscitation or terminal care.
 

Infants from peripheral centres may require transfer for cooling. For a short distance transfer within the city passive cooling is likely to be adequate, particularly if the infant is transferred quickly to the level 3 centre for cooling.

NB. Infants should not be cooled without monitoring of core temperature.

Although cooling is generally well tolerated there are a number of potential complications that should be anticipated.

Complications:

NB. hypothermia will potentially slow down the metabolism and / or excretion of drugs including opiates 6, anticonvulsants and aminoglycoside antibiotics. Thus care should be taken with dosing and monitoring of levels to avoid excessive accumulation.

Application of Cooling

Care is taken to not overheat the infant prior to cooling

Follow up of baby after cooling completed

Step

Action

1

  • Neurological examination of the baby and head circumference, weight and length measurements
  • Electroencephalogram and magnetic resonance imaging (MRI) to be done when clinically possible
  • Any tests that were abnormal at 72 hours, such as an elevated
    creatinine level should be repeated.

2

Review at 3 months of age:
  • At 3 months there should be follow up clinic visits with the paediatrician with neurodevelopmental examination and measurements of head circumference, weight and length.
  • Audiology assessment as outpatient

3

Age 18 months to two years:

  • Neurodevelopmental examination by a paediatrician, measurement of head circumferences, weight and length.

  • Formal psychometric testing by a clinical psychologist

References

1 Hypothermia to treat neonatal hypoxic ischemic encephalopathy: systematic review. Shah PS, Ohlsson A, Perlman M. Arch Pediatr Adolesc Med. 2007;161(10):951-8
2 Cooling for newborns with hypoxic ischaemic encephalopathy. Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cochrane Database Syst Rev. 2007;(4):CD003311.
3 A systematic review of cooling for neuroprotection in neonates with hypoxic ischemic encephalopathy - are we there yet? Schulzke SM, Rao S, Patole SK. BMC Pediatr. 2007;7:30.
4 Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. Shankaran S, Laptook AR, Ehrenkranz RA, et al. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med. 2005;353:1574-84
5 Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Gluckman PD, Wyatt JS, Azzopardi D, et al. Lancet. 2005;365(9460):663-70
6 Elevated morphine concentrations in neonates treated with morphine and prolonged hypothermia for hypoxic ischemic encephalopathy. Róka A, Melinda KT, Vásárhelyi B, Machay T, Azzopardi D, Szabó M. Pediatrics. 2008 Apr;121(4):e844-9.