Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 0910 (2013)

Feasibility and safety of passive cooling in a cohort of asphyxiated newborn infants

  • Karin Daetwyler
  • Barbara Brotschi
  • Thomas M Berger
  • Bendicht Peter Wagner
DOI
https://doi.org/10.4414/smw.2013.13767
Cite this as:
Swiss Med Wkly. 2013;143:w13767
Published
24.02.2013

Summary

OBJECTIVE: Therapeutic hypothermia has become a standard neuroprotective treatment in term newborn infants following perinatal asphyxia. Active cooling with whole body surface or head cooling is complex, expensive and often associated with initial hypothermic overshoot. We speculated that passive cooling might suffice to induce and maintain hypothermia.

METHODS: We analysed 18 asphyxiated term newborns treated with hypothermia in three tertiary neonatal and paediatric intensive care units. Target temperatures of 33.5 °C or 33.0 °C were induced and maintained by turning off the heating system of the open neonatal care unit and by using analgesics and sedatives. We compared our results with matching published data from the hypothermia trial of the National Institute of Child Health and Human Development (NICHD) neonatal research network.

RESULTS: Four infants required no active cooling at all during the whole cooling period. The other 14 infants had passive cooling during 85% of the total cooling time, and active cooling with ice packs in 15% of the total cooling time. Overshoot was smaller in the present study than in the NICHD study.

CONCLUSION: Passive cooling for asphyxiated newborns appears to be feasible for induction and maintenance of hypothermia with a lower risk of overshoot.

References

  1. Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol. 2005;32(1):11–7.
  2. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365(9460):663–70.
  3. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353(15):1574–84.
  4. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361(14):1349–58.
  5. Simbruner G, Mittal RA, Rohlmann F, Muche R, neo.nEURO.network Trial Participants. Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics. 2010;126(4):e771–8.
  6. Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ, 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(8):692–700.
  7. Polderman KH, Herold I. Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods. Crit Care Med. 2009;37(3):1101–20.
  8. Weinrauch V, Safar P, Tisherman S, Kuboyama K, Radovsky A. Beneficial effect of mild hypothermia and detrimental effect of deep hypothermia after cardiac arrest in dogs. Stroke. 1992;23(10):1454–62.
  9. Hey EN. The relation between environmental temperature and oxygen consumption in the newborn baby. J Physiol. 1969;200(3):589–603.
  10. Tooley JR, Satas S, Porter H, Silver IA, Thoresen M. Head cooling with mild systemic hypothermia in anesthetized piglets is neuroprotective. Ann Neurol. 2003;53(1):65–72.
  11. Miller JA. Factors in Neonatal Resistance to Anoxia. I. Temperature and Survival of Newborn Guinea Pigs Under Anoxia. Science. 1949;110(2848):113–4.
  12. Gautier H. Interactions among metabolic rate, hypoxia, and control of breathing. J Appl Physiol. 1996;81(2):521–7.
  13. Wagner BP, Nedelcu J, Martin E. Delayed postischemic hypothermia improves long-term behavioral outcome after cerebral hypoxia-ischemia in neonatal rats. Pediatr Res. 2002;51(3):354–60.
  14. Adcock KH, Nedelcu J, Loenneker T, Martin E, Wallimann T, Wagner BP. Neuroprotection of creatine supplementation in neonatal rats with transient cerebral hypoxia-ischemia. Dev Neurosci. 2002;24(5):382–8.
  15. Shankaran S, Pappas A, Laptook AR, McDonald SA, Ehrenkranz RA, Tyson JE, et al. Outcomes of safety and effectiveness in a multicenter randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatrics. 2008;122(4):e791–8.
  16. Robertson NJ, Nakakeeto M, Hagmann C, Cowan FM, Acolet D, Iwata O, et al. Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial. Lancet. 2008;372(9641):801–3.
  17. Kendall GS, Kapetanakis A, Ratnavel N, Azzopardi D, Robertson NJ. Cooling on Retrieval Study Group. Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F408–12.
  18. Sweney MT, Sigg DC, Tahvildari S, Iaizzo PA. Shiver Suppression Using Focal Hand Warming in Unanesthetized Normal Subjects. Anesthesiology. 2001;95(5):1089–95.
  19. Laptook A. Use of Therapeutic hypothermia for term infants with hypoxic-ischemic encephalopathy. Pediatr Clin N Am. 2009;56:601–16.
  20. Strohm B, Azzopardi D. UK TOBY Cooling Register Study Group. Temperature control during therapeutic moderate whole-body hypothermia for neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2010;95(5):F373–5.
  21. Hoque N, Chakkarapani E, Liu X, Thoresen M. A comparison of cooling methods used in therapeutic hypothermia for perinatal asphyxia. Pediatrics. 2010;126(1):e124–30.

Most read articles by the same author(s)