Purpose:  To outline the process for initiating Infant Cooling on transport.

Patient Population:  Patients who qualify for cooling in transport meet the same criteria as those who have been enrolled in cooling in the NICU.  They should be:

A. Greater than or equal to 36 completed weeks gestation and with at least one of the following:

*  Apgar Score <5 at 10 minutes after birth

*  Continued need for resuscitation, including endotracheal or mask ventilation, at 10 minutes after birth due to hypoxia.

*  Significant acidosis within 60 minutes of birth, (defined as any pH, umbilical, arterial, venous, or capillary, <7.00) 

*  Base deficit = 16 mmol/L in any blood sample, umbilical, arterial, venous or capillary, within 60 minutes of birth.

and exhibit one or more of the following:

B. Seizures or moderate to severe encephalopathy consisting of:

*  Altered state of consciousness (reduced response to stimulation or absent response to stimulation) and/or

*  Abnormal tone (focal or general hypotonia, or flaccid) and/or

*  Abnormal primitive reflexes (weak or absent suck or Moro Reflex)

Procedure Goal:  To begin cooling sooner in the patient population that will benefit from its affects. To achieve and/or maintain the rectal temperature at 34.5 degrees, (34.0-35.0)

Special Instructions:

1.  A temperature probe should be placed rectally to a depth of 5cm. and secured to the infant’s thigh with tape.

2.  The temperature is achieved/maintained by managing the patient in the isolette with the heat source turned off.  (Prior to transferring the infant to the isolette in the referral hospital the infant should be managed in the open bed warmer with the heat source turned off.)

3. Should the temperature be greater than 35.0 degrees with the heat source off the patient can be further cooled by placing plastic bags or disposable gloves filled with cold water, (not ice), around the head and body but not in direct contact with the skin. 

4. Should the temperature be less than 34.0 degrees the infant may be warmed by isolette.

5.  If the criteria for head cooling have been met at the time of the transport call and the patient is deemed appropriate for this therapy,  the Vanderbilt physician taking the transport call should inform the referring physician and recommend that the patient be maintained with the heat source off.  The referral hospital should also be advised to monitor the infant’s rectal temperature every 15 minutes with a goal temperature between 33 and 36 degrees C (or 91.4 and 96.8 F).  The heart rate and blood pressure should also be monitored and recorded at least every 15 minutes.

Sources:

UK TOBY Cooling Registry Clinician’s Handbook, section 2.1.

HIE and Head Cooling Overview, VUNEO. org 8/1/07