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

Considerations for Management of Pain and Discomfort

Although several authors acknowledge the use of sedation, less is discussed about pain measurement and management in the infant undergoing therapeutic hypothermia. The role of sedation is to decrease excess activity that could elevate the temperature of the body, interfering with the goal of therapeutic hypothermia, and may place the infant at an increased risk for seizure activity.[4] According to Simbruner et al,[39] the clinical trial (neo.nEURO.network) used routine pain and anxiety medications to control symptoms in patients with HIE and showed favorable outcomes, with lower incidence of death or severe disability compared with previously published trials.[27] Opioids have been shown to have "neuroprotective" properties and may have a more pronounced effect during hypothermia by blunting the stress and metabolic responses to hypothermia.[39] Typically administered at routine intervals or by continuous infusion, the goal was directed at reducing discomfort secondary to encephalopathy.

Hypothermia also decreases elimination and alters the pharmokinetic characteristics of morphine. Medications that are excreted unchanged by the kidneys are less affected by temperature, whereas medications that are metabolized by the liver have been shown to have higher levels in the hypothermic infant.[30] However, there are currently no general recommendations for treating hypothermic infants differently than "normothermic" infants.

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