RT Journal Article
SR Electronic
T1 Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F408
OP F412
DO 10.1136/adc.2010.187211
VO 95
IS 6
A1 Giles S Kendall
A1 Andrew Kapetanakis
A1 Nandiran Ratnavel
A1 Denis Azzopardi
A1 Nicola J Robertson
YR 2010
UL http://fn.bmj.com/content/95/6/F408.abstract
AB Objective To determine the feasibility of passive cooling to initiate therapeutic hypothermia before and during transport. Methods Consensus guidelines were developed for passive cooling at the referring hospital and on transport by the London Neonatal Transfer Service. These were evaluated in a prospective study. Results Between January and October 2009, 39 infants were referred for therapeutic hypothermia; passive cooling was initiated at the referring hospital in all the cases. Despite guidance, no rectal temperature measurements were taken before arrival of the transfer team. Cooling below target temperature (33°C–34°C) occurred in five babies before the arrival of the transfer team. In two of these infants, active cooling was performed, rectal temperature was not recorded and their temperature was lower than 32°C. Of the remaining 37 babies, 33 (89%) demonstrated a reduction in core temperature with passive cooling alone. The percentage of the babies within the temperature range at referral, arrival of the transfer team and arrival at the cooling centre were 0%, 15% and 67%, respectively. On arrival at the cooling centre, four babies had cooled to lower than 33°C by passive cooling alone (32.7°C, 32.6°C, 32.2°C and 32.1°C). Initiation of passive cooling before and during transfer resulted in the therapy starting 4.6 (1.8) h earlier than if initiated on arrival at the cooling centre. Conclusions Passive cooling is a simple and effective technique if portable cooling equipment is unavailable. Rectal temperature monitoring is essential; active cooling methods without core temperature monitoring may lead to overcooling.