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


NAINR. 2011;11(3):113-124. 

In This Article

Complications of Hypothermia

The nurse's position at the bedside affords the first line of intervention when complications arise in the infant with HIE undergoing cooling therapy. An intimate understanding of what to anticipate and the transient changes in baseline monitoring parameters are needed. Several complications also occur as a result of asphyxia and/or hypothermia (see Table 4). Bradycardia may also occur but subsides when the infant is warmed slightly. Monitoring for other cardiac arrhythmias is also necessary, as these have been reported.[4,5,27]

Hypotension may also occur secondary to hypovolemia, reduced cardiac output, and reduced stroke volume. A reduced blood flow and hyperviscosity have been reported in the hypothermic infant, which poses a potential risk for microembolism, but evidence does not show the cooled infant to suffer more emboli than the other infants.[4]

Coagulation is prolonged during hypothermia, but if the coagulation is normal before cooling, the infant should not experience problems as a result of the cooling therapy. It is not unusual, however, for the asphyxiated patient to have abnormal clotting studies secondary to hypoxic injury to the liver. Monitoring of liver function tests (LFTs) as well as other clotting studies would be indicated at regular intervals. The nurse will also be cognizant of physical signs of coagulopathy, such as petechiae; oozing from heelsticks or venipuncture sites; or bloody urine, gastric secretions, or endotracheal secretions.

Any infant who had a traumatic delivery should especially be monitored for bleeding, especially subgaleal hemorrhages. Trauma to the head would contraindicate selective head cooling and aggressive management of the bleeding with administration of fresh frozen plasma, cryoprecipitate, blood, and volume, as indicated. Electrolytes should be monitored closely to maintain reference ranges, and the bedside expert should be knowledgeable regarding normal laboratory values. Monitoring of blood glucose levels to avoid excess at each end of the spectrum is important to meeting basic metabolic and nutritional needs.[27,30] Attention to the urinary output is discussed above. The risk for seizures and skin complications is discussed in later sections of this article. Side effects often resolve or return to baseline with the return to normothermic temperature, as discussed in the rewarming section. Of note, most side effects did not interfere with the management of providing hypothermia during clinical trials. Described protective benefits far outweighed potential side effects.[2,26,27]


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