Therapeutic Hypothermia during Neonatal Transport: Current Practices in California

Abstract

Therapeutic hypothermia initiated at <6 hours of age reduces death and disability in newborns ≥ 36 weeks' gestation with moderate to severe hypoxic ischemic encephalopathy. Given the limited therapeutic window, cooling during transport becomes a necessity. Our goal was to describe the current practice of therapeutic hypothermia during transport used in the state of California. All level III neonatal intensive care units (NICUs) were contacted to identify those units providing therapeutic hypothermia. An electronic questionnaire was sent to obtain basic information. Responses were received from 28 (100%) NICUs performing therapeutic hypothermia; 26 NICUs were cooling newborns and two were in the process of program development. Eighteen (64%) centers had cooled a patient in transport, six had not yet cooled in transport, and two do not plan to cool in transport. All 18 centers use passive cooling, except for two that perform both passive and active cooling, and 17 of 18 centers recommend initiation of cooling at the referral hospital. Reported difficulties include overcooling, undercooling, and bradycardia. Cooling on transport is being performed by majority of NICUs providing therapeutic hypothermia. Clinical protocols and devices for cooling in transport are essential to ensure safety and efficacy.

A Randomized Clinical Trial of Therapeutic Hypothermia Mode during Transport for Neonatal Encephalopathy

“…A survey of cooling centers in California in 2010 showed that 64% performed cooling in transport. 22 The same authors found that only 44% of infants cooled in transport achieved a target temperature (33 C-34 C) at the time of admission to the cooling center. 16 Fairchild et al used passive cooling at referral and active cooling by transport team.…”

Passive hypothermia (≥35 - <36°C) during transport of newborns with hypoxic-ischaemic encephalopathy

“…In one study, as many as one third of infants arrived in NICU with a core temperature of <33°C [23]. Deep hypothermia may induce bradycardia and arrhythmia [20], thrombocytopaenia [6] requiring platelet transfusion [21] although overall haemostasis may not be affected [22]. …”

Therapeutic Hypothermia in Asphyxiated Neonates with Hypoxic-ischemic Encephalopathy: A single-center Experience from its First Application in Saudi Arabia

“…Infant Cooling Evaluation Collaboration (ICE study) clinical trial has reported that whole body cooling using low tech methods was safe and effective for HIE cases. Owing to its practicality and low cost, it is used by several centers even in high resource countries [14,22,23] . Still, one should be aware of the highest variation of temperature with this cooling method [14] .…”

“…Ongoing studies on this issue by NICDH reported a term late hypothermia that could be expected to provide insights as to whether the later timely application of therapeutic hypothermia is beneficial [9] . Cooling during transport could be an alternative approach as initiation of effective hypothermia is achieved significantly earlier, but clinical protocols and devices for cooling in transport are essential to ensure safety and efficacy [23,25] .…”