title: Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia.
abstract: OBJECTIVE
  To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxic-ischemic encephalopathy treated with moderate whole-body hypothermia.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Neonatal Intensive Care Unit (NICU).
  
  
  METHODS
  Thirty-nine neonates cooled in the considered period.
  
  
  METHODS
  Starting from January 2008, for neonates treated with moderate whole-body hypothermia (33.5 °C), the cooling system was set in "automatic servo-controlled mode (ACM)", where the temperature of the circulating water could vary between 4 °C and 42 °C. Starting from January 2009, cooling blankets were used in another type of automatic mode, the "gradient variable mode (GVM)", where the circulating water was maintained at a specific pre-set gradient towards the patient's body temperature, and a specific nursing protocol (NP) was adopted.
  
  
  RESULTS
  Two of the eleven newborns treated with the "ACM" exhibited skin complications compatible with subcutaneous fat necrosis (SFN). None of the twenty-eight newborns treated with the "GVM" exhibited skin complications. A comparison of the biochemical and hematological data between these two groups revealed that newborns treated after the adopting of a NP and the "GVM" showed lower serum protein C and calcium levels, and higher platelet levels.
  
  
  CONCLUSIONS
  Our data suggest that newborns undergoing therapeutic cooling may benefit from a specific NP and correct cooling unit setting. Should further studies confirm our data, this nursing approach could be easily adopted.
authors.affiliation: Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, A. Meyer University Children's Hospital, Florence, Italy. l.filippi@meyer.it
authors.forename: Luca
authors.initials: L
authors.lastname: Filippi
authors.forename: Serena
authors.initials: S
authors.lastname: Catarzi
authors.forename: Letizia
authors.initials: L
authors.lastname: Padrini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Fiorini
authors.forename: Giancarlo
authors.initials: G
authors.lastname: la Marca
authors.forename: Renzo
authors.initials: R
authors.lastname: Guerrini
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Donzelli
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D005218:Fat Necrosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D015434:Panniculitis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D050151:Subcutaneous Fat / Q000473:pathology*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D002118:Calcium