Therapeutic Hypothermia for Neonatal Encephalopathy
What does all this mean for nursing? To start with, we know that TH is an effective treatment for NE and more nurseries are implementing its use. Therefore, education is needed regarding care of the cooled infant. Knowledge regarding management of TH from the identification of potential candidates to the management of treatment itself can allow for seamless transition from one phase to the next.
There are two main methods for implementing TH – whole body cooling, which is the most common, and selective head cooling. The type of cooling varies by institution; however, both methods have been shown to be safe and effective at bringing down core body temperature to the target level. Selective head cooling involves a cap placed on the infant's head that circulates cold water to lower the infant's core temperature. With this method, the infant's head and brain structures reach a cooler temperature than the body. Target rectal or esophageal temperature during selective head cooling is 34–35 °C. Whole body cooling is typically implemented via a cooling blanket placed under the baby that circulates cold water to achieve homogenous cooling of the entire body. Target rectal or esophageal temperature during whole body hypothermia is 33–34 °C. Both cooling devices have automatic control modes where the device monitors the baby's temperature with an attached temperature probe and maintains the desired target temperature, programmed by the user, by changing the temperature of circulating water. Security features, such as alarms and screen prompts notify users of unexpected changes in temperature.
It is important to note that not all hospital facilities are outfitted with the equipment required to implement cooling. Several studies have evaluated passive cooling as a technique to diminish heat retention prior to transport and active cooling. Passive cooling was found to be a simple and efficient way to initiate TH as long as appropriate temperature monitoring was used concurrently. Additionally, passive cooling allowed for therapy to begin nearly 5 hours earlier than if therapy was started after transport. To initiate passive cooling, turn off external heating devices and remove hats, clothing, and blankets. Serial monitoring of rectal temperatures every 15 minutes during passive cooling should be done to prevent the temperature from getting too low.
Nursing Considerations
What does all this mean for nursing? To start with, we know that TH is an effective treatment for NE and more nurseries are implementing its use. Therefore, education is needed regarding care of the cooled infant. Knowledge regarding management of TH from the identification of potential candidates to the management of treatment itself can allow for seamless transition from one phase to the next.
Cooling Methods
There are two main methods for implementing TH – whole body cooling, which is the most common, and selective head cooling. The type of cooling varies by institution; however, both methods have been shown to be safe and effective at bringing down core body temperature to the target level. Selective head cooling involves a cap placed on the infant's head that circulates cold water to lower the infant's core temperature. With this method, the infant's head and brain structures reach a cooler temperature than the body. Target rectal or esophageal temperature during selective head cooling is 34–35 °C. Whole body cooling is typically implemented via a cooling blanket placed under the baby that circulates cold water to achieve homogenous cooling of the entire body. Target rectal or esophageal temperature during whole body hypothermia is 33–34 °C. Both cooling devices have automatic control modes where the device monitors the baby's temperature with an attached temperature probe and maintains the desired target temperature, programmed by the user, by changing the temperature of circulating water. Security features, such as alarms and screen prompts notify users of unexpected changes in temperature.
It is important to note that not all hospital facilities are outfitted with the equipment required to implement cooling. Several studies have evaluated passive cooling as a technique to diminish heat retention prior to transport and active cooling. Passive cooling was found to be a simple and efficient way to initiate TH as long as appropriate temperature monitoring was used concurrently. Additionally, passive cooling allowed for therapy to begin nearly 5 hours earlier than if therapy was started after transport. To initiate passive cooling, turn off external heating devices and remove hats, clothing, and blankets. Serial monitoring of rectal temperatures every 15 minutes during passive cooling should be done to prevent the temperature from getting too low.