title: Cooling in surgical patients: two case reports.
abstract: Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it.
authors.affiliation: Neonatal Unit, Royal Albert Edward Infirmary, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan Lane, Wigan WN1 2NN, UK.
authors.forename: Bibi F
authors.initials: BF
authors.lastname: Gurreebun
authors.affiliation: Neonatal Unit, Royal Albert Edward Infirmary, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan Lane, Wigan WN1 2NN, UK ; Manchester Academic Heath Science Centre, The University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.
authors.forename: Christos S
authors.initials: CS
authors.lastname: Zipitis
authors.affiliation: Manchester Academic Heath Science Centre, The University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK ; Newborn Intensive Care Unit, Central Manchester University Hospitals NHS Trust, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Ngozi E
authors.initials: NE
authors.lastname: Edi-Osagie
authors.affiliation: Newborn Intensive Care Unit, Central Manchester University Hospitals NHS Trust, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Dady
authors.affiliation: Neonatal Unit, Royal Albert Edward Infirmary, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan Lane, Wigan WN1 2NN, UK.
authors.forename: Axel
authors.initials: A
authors.lastname: Sylvan