Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU.
OBJECTIVE
Therapeutic hypothermia instituted within 6 h of birth has been shown to improve neurodevelopmental outcomes in term newborns with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The majority of infants who would benefit from cooling are born at centers that do not offer the therapy, and adding the time for transport will result in delays in therapy, that may lead to suboptimal or no neuroprotection for some patients. Our objective was to evaluate the effect of our center's experience with therapeutic hypothermia on neonatal transport.


METHODS
Retrospective review of all cases of therapeutic hypothermia at a single neonatal intensive care unit from 2005 to 2009.


RESULTS
Of 50 infants with HIE treated with hypothermia, 40 were outborn and 35 were cooled on transport. The majority of patients were passively cooled by the referring clinicians, then actively cooled by our transport team. Overcooling to <32 degrees C occurred in 34% of patients, but there were no significant differences in admission vital signs or laboratory values between overcooled and appropriately cooled infants. The average time after birth of initiation of passive cooling was 1.4 h and active cooling was 2.7 h compared with the time of admission to our unit of 5.9 h.


CONCLUSIONS
We discuss the important aspects of our program, including the education of referring and receiving clinicians and avoidance of overcooling.
Fairchild
K
K
Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA. kdf2n@virginia.edu
Sokora
D
D
Scott
J
J
Zanelli
S
S
D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D012017:Referral and Consultation; D012189:Retrospective Studies; D014187:Transportation of Patients; D016896:Treatment Outcome