A comparison of cooling methods used in therapeutic hypothermia for perinatal asphyxia.
OBJECTIVE
The objective of this study was to compare cooling methods during therapeutic hypothermia (TH) for moderate or severe perinatal asphyxia with regard to temperature and hemodynamic stability.


METHODS
A total of 73 newborns received TH in our center between 1999 and 2009 by 4 methods: (1) selective head cooling with mild systemic hypothermia by using cap (SHC; n = 20); (2) whole-body cooling with mattress manually controlled (WBCmc; n = 23); (3) whole-body cooling with body wrap servo-controlled (WBCsc; n = 28); and (4) whole-body cooling with water-filled gloves (n = 2). Target rectal temperatures (Trec) were 34.5 +/- 0.5 degrees C (SHC) and 33.5 +/- 0.5 degrees C (WBC). Trec, mean arterial blood pressure, and heart rate were collected from retrospective chart review.


RESULTS
Groups had similar baseline characteristics and condition at birth. Trec was within target temperature +/-0.5 degree C for 97% of the time in infants with WBCsc, 81% in infants with WBCmc, 76% in infants with SHC, and 74% in infants who were cooled with gloves. Mean overshoot was 0.3 degree C for WBCsc, 1.3 degrees C for WBCmc, and 0.8 degree C for SHC groups. There was no difference in mean arterial blood pressure or mean heart between groups during the maintenance of cooling. In infants who were rewarmed at similar speed, there was greater variation in Trec in the SHC compared with the WBCsc group.


CONCLUSIONS
Manually controlled cooling systems are associated with greater variability in Trec compared with servo-controlled systems. A manual mattress often causes initial overcooling. It is unknown whether large variation in temperature adversely affects the neuroprotection of TH.
Child Health, School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, Avon, UK.
Nicholas
N
Hoque
Ela
E
Chakkarapani
Xun
X
Liu
Marianne
M
Thoresen
D000704:Analysis of Variance; D001238:Asphyxia Neonatorum / Q000175:diagnosis* / Q000628:therapy*; D001795:Blood Pressure Determination; D001831:Body Temperature / Q000502:physiology; D001833:Body Temperature Regulation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods*; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013817:Thermography; D013997:Time Factors; D016896:Treatment Outcome