Neonatal Hypothermia

A Method to Provide Neuroprotection After Hypoxic Ischemic Encephalopathy

Katherine M. Newnam, MS, RN, CPNP, NNP-BC; Donna L. DeLoach, MS, RN, CPNP, NNP-BC

Disclosures

NAINR. 2011;11(3):113-124. 

In This Article

Abstract and Introduction

Abstract

The evolving progression of hypoxic ischemic encephalopathy has devastating effects accounting for approximately 23% of the four million annual neonatal deaths globally. Of infants who survive, 25% to 55% will suffer significant neurologic sequelae (Pediatrics 2008;121:648-649; author reply 649-650). Scientific evidence has demonstrated significant improvements in clinical and developmental outcomes through therapeutic hypothermia. Interventions initiated within a predefined "therapeutic window" showed decreased secondary cellular injury and aptotosis. The aim of this article is to provide an account of the hypoxic event at the cellular level describing the progression of injury that leads to ongoing neuronal cell damage and death. Historical accounts of experimental and clinical trials to date are provided, which describe scientific evidence used to develop standardized treatment protocols for hypothermia after hypoxic ischemic encephalopathy. Details of current protocols are also provided. Lastly, a focus on nursing interventions with symptom management is provided, giving supportive rationale to assist the bedside nurse when caring for these complex patients in an effort to potentially improve short- and long-term outcomes.

Introduction

The topic of neonatal hypothermia and its effect on perinatal asphyxia is widespread throughout recent literature. Well-designed experimental studies based on earlier work using animal models are now guiding our treatment with cooling protocols for term infants in neonatal intensive care units (NICUs) across the United States.[1] Multiple systematic reviews and meta-analysis are available to describe the journey from first attempts of cold submersion in the 1950s through the well-organized clinical trials that now define neuroprotection with hypothermia protocols.[2–5] Proposed recommendations for future research are often included in these works that include hypothermia trials on younger neonates (34–36 week of gestation) and combination therapies to augment the protective effect of hypothermia and longitudinal studies to best describe long-term outcomes after hypothermia. A missing piece of the literature to date involves implications for care of these infants provided by expert nurses in the NICU. Understanding the scientific rationale that directs our care for these specialized patients will lead to best practices at the bedside with the potential to impact clinical and developmental outcomes. The focus of this article begins with an understanding of perinatal asphyxia and hypoxic ischemic encephalopathy (HIE). A discussion of hypothermia treatment including the nursing care implications for these infants will follow; finally, an emphasis on the long-term developmental outcomes, providing nursing strategies that potentially will improve these severely affected infants.

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