Limits...
Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU.

Fairchild K, Sokora D, Scott J, Zanelli S - J Perinatol (2009)

Bottom Line: The majority of infants who would benefit from cooling are born at centers that do not offer the therapy, and adding the time for transport will result in delays in therapy, that may lead to suboptimal or no neuroprotection for some patients.Overcooling to <32 degrees C occurred in 34% of patients, but there were no significant differences in admission vital signs or laboratory values between overcooled and appropriately cooled infants.The average time after birth of initiation of passive cooling was 1.4 h and active cooling was 2.7 h compared with the time of admission to our unit of 5.9 h.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA. kdf2n@virginia.edu

ABSTRACT

Objective: Therapeutic hypothermia instituted within 6 h of birth has been shown to improve neurodevelopmental outcomes in term newborns with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The majority of infants who would benefit from cooling are born at centers that do not offer the therapy, and adding the time for transport will result in delays in therapy, that may lead to suboptimal or no neuroprotection for some patients. Our objective was to evaluate the effect of our center's experience with therapeutic hypothermia on neonatal transport.

Study design: Retrospective review of all cases of therapeutic hypothermia at a single neonatal intensive care unit from 2005 to 2009.

Result: Of 50 infants with HIE treated with hypothermia, 40 were outborn and 35 were cooled on transport. The majority of patients were passively cooled by the referring clinicians, then actively cooled by our transport team. Overcooling to <32 degrees C occurred in 34% of patients, but there were no significant differences in admission vital signs or laboratory values between overcooled and appropriately cooled infants. The average time after birth of initiation of passive cooling was 1.4 h and active cooling was 2.7 h compared with the time of admission to our unit of 5.9 h.

Conclusion: We discuss the important aspects of our program, including the education of referring and receiving clinicians and avoidance of overcooling.

Show MeSH

Related in: MedlinePlus

The University of Virginia (UVA) admission temperature for 35 outborn infants cooled on transport. The rectal temperatures of 35 outborn infants cooled during transport, recorded on admission to the UVA Neonatal Intensive Care Unit. Gray-shaded area represents target temperature (33 to 34 °C). Two patients with only passive cooling during transport (indicated with an open circle) had admission temperatures of 34.4 and 34.8 °C. All others were transported with active cooling.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2864418&req=5

fig3: The University of Virginia (UVA) admission temperature for 35 outborn infants cooled on transport. The rectal temperatures of 35 outborn infants cooled during transport, recorded on admission to the UVA Neonatal Intensive Care Unit. Gray-shaded area represents target temperature (33 to 34 °C). Two patients with only passive cooling during transport (indicated with an open circle) had admission temperatures of 34.4 and 34.8 °C. All others were transported with active cooling.

Mentions: Figure 3 shows, by year, the UVA admission temperature for patients cooled on transport. The mean admission temperature increased every year and by 2008 two-thirds of patients fell in the target range of 33 to 34 °C.


Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU.

Fairchild K, Sokora D, Scott J, Zanelli S - J Perinatol (2009)

The University of Virginia (UVA) admission temperature for 35 outborn infants cooled on transport. The rectal temperatures of 35 outborn infants cooled during transport, recorded on admission to the UVA Neonatal Intensive Care Unit. Gray-shaded area represents target temperature (33 to 34 °C). Two patients with only passive cooling during transport (indicated with an open circle) had admission temperatures of 34.4 and 34.8 °C. All others were transported with active cooling.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864418&req=5

fig3: The University of Virginia (UVA) admission temperature for 35 outborn infants cooled on transport. The rectal temperatures of 35 outborn infants cooled during transport, recorded on admission to the UVA Neonatal Intensive Care Unit. Gray-shaded area represents target temperature (33 to 34 °C). Two patients with only passive cooling during transport (indicated with an open circle) had admission temperatures of 34.4 and 34.8 °C. All others were transported with active cooling.
Mentions: Figure 3 shows, by year, the UVA admission temperature for patients cooled on transport. The mean admission temperature increased every year and by 2008 two-thirds of patients fell in the target range of 33 to 34 °C.

Bottom Line: The majority of infants who would benefit from cooling are born at centers that do not offer the therapy, and adding the time for transport will result in delays in therapy, that may lead to suboptimal or no neuroprotection for some patients.Overcooling to <32 degrees C occurred in 34% of patients, but there were no significant differences in admission vital signs or laboratory values between overcooled and appropriately cooled infants.The average time after birth of initiation of passive cooling was 1.4 h and active cooling was 2.7 h compared with the time of admission to our unit of 5.9 h.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA. kdf2n@virginia.edu

ABSTRACT

Objective: Therapeutic hypothermia instituted within 6 h of birth has been shown to improve neurodevelopmental outcomes in term newborns with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The majority of infants who would benefit from cooling are born at centers that do not offer the therapy, and adding the time for transport will result in delays in therapy, that may lead to suboptimal or no neuroprotection for some patients. Our objective was to evaluate the effect of our center's experience with therapeutic hypothermia on neonatal transport.

Study design: Retrospective review of all cases of therapeutic hypothermia at a single neonatal intensive care unit from 2005 to 2009.

Result: Of 50 infants with HIE treated with hypothermia, 40 were outborn and 35 were cooled on transport. The majority of patients were passively cooled by the referring clinicians, then actively cooled by our transport team. Overcooling to <32 degrees C occurred in 34% of patients, but there were no significant differences in admission vital signs or laboratory values between overcooled and appropriately cooled infants. The average time after birth of initiation of passive cooling was 1.4 h and active cooling was 2.7 h compared with the time of admission to our unit of 5.9 h.

Conclusion: We discuss the important aspects of our program, including the education of referring and receiving clinicians and avoidance of overcooling.

Show MeSH
Related in: MedlinePlus