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

Pain Evaluation for the Infant After Hypoxia: A Complicated Assessment

Multiple pain scales are readily available, which have been well validated in infants; however, these tools often rely on an unaltered response of the infant. Mild manifestations of HIE include initial hypotonia, which progresses to slightly increased muscle tone and deep tendon reflexes, and transient behavioral abnormalities usually demonstrated by poor feeding and temperature instability.[40] The infant may initially demonstrate a hyperalertness, appear to be staring, and have a decreased threshold for all types of external stimulation.[28] Stage I or mild HIE would not require hypothermia management. Moderately severe infants with HIE exhibit lethargy, significant hypotonia and decreased deep tendon reflexes, decreased or absent primary reflexes (moro, suck, grasp), possible apnea, and a risk for seizures with the first 24 hours after birth.[40] The lethargic or obtunded infant will demonstrate a full response to stimulation but an increased threshold for eliciting such response. These infants are also irritable when stimulated.[28] The most critical infants may deteriorate to a coma or stupor and may not be able to respond to any stimuli. These conditions and behaviors interfere with the infant's ability to express pain. The level of alertness typically improves by 4 to 5 days of life in infants who survive severe HIE.[18] Alternate methods for valid and reliable pain scale to be used in this altered neurologic state are needed.


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