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

Implications for Nursing

As described earlier in the article, the focus of care for these infants before the initiation of hypothermia treatment was intensive supportive care. Physiologic disturbances of the infant were usually global in nature, specifically affecting the neurologic, cardiovascular, respiratory, and metabolic systems, which required monitoring and interventions. The hemodynamic issues of the cardiovascular system typically require management of hypotension with vassopressors and inotropes, monitoring of clotting disorders, and treatment with blood products as well as additional clotting factors. Pulmonary concerns include the treatment and correction of hypoventilation and acidosis because these infants often require intubation with ventilator support. Management of neurologic issues surrounds the identification and treatment of cerebral edema and hypoxic injury. Seizures are often identified and treated with pharmacologic intervention. Metabolic treatment involves close regulation, monitoring, and treatment of glucose, calcium, and magnesium disorders and global electrolyte issues. Metabolic acidosis is common and will often need close management. Anuria or oliguria secondary to the renal system injury from hypoxia will need attention and can impact the critical balance of other physiologic systems, primarily pulmonary and metabolic systems.

Although the goal of hypothermia treatment is to ameliorate the brain injury that these patients suffer, many systemic effects are still present during the acute and recovery phase of HIE. Each of these presents significant nursing implications to understand the underlying neonatal physiology that occurs during the acute and latent phases of HIE as rationale for care of these complex neonates. This understanding should provide bedside nurses the tools necessary to develop critically analysis and intervention strategies when subtle changes are noted. Constant and vigilant observation by the bedside nurse is a critical part of the health care management of these patients. Focused attention on these described aspects of care could improve short- and long-term outcomes for these complex infants.

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