title: Cooling neonates who do not fulfil the standard cooling criteria - short- and long-term outcomes.
abstract: OBJECTIVE
  Therapeutic hypothermia is effective and without serious adverse effects in term infants with hypoxic-ischaemic encephalopathy. It is unknown whether other neonatal patient groups could benefit from therapeutic hypothermia. Since 2006, our centre has offered cooling to infants fulfilling the standard cooling criteria, but also to those who did not.
  
  
  METHODS
  Observational study with prospective data collection over a 6-year period in a regional cooling centre. Complications and outcome were compared between infants who were cooled not fulfilling the standard inclusion and exclusion criteria as set out in the CoolCap/TOBY protocol (n = 36) and infants who fulfilled the standard entry criteria (n = 129).
  
  
  RESULTS
  21.8% of cooled infants did not fulfil standard cooling entry criteria. This included infants cooled >6 postnatal hours, late preterm infants, and infants with postnatal collapse, major cranial haemorrhage, congenital cardiac disease and surgical conditions. Complication rates and long-term outcome did not differ significantly between the groups, apart from in infants with a major cranial haemorrhage, who had higher rates of coagulopathy and the worst outcome (80% death/disability).
  
  
  CONCLUSIONS
  Cooling can be considered for infants with neonatal encephalopathy following postnatal collapse or preterm birth, those with underlying surgical or cardiac conditions, and infants starting cooling >6 postnatal hours.
authors.affiliation: Department of Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK; Neonatal Intensive Care Unit, St Michaels Hospital, University Hospitals Bristol, Bristol, UK.
authors.forename: Elisa
authors.initials: E
authors.lastname: Smit
authors.forename: Xun
authors.initials: X
authors.lastname: Liu
authors.forename: Sally
authors.initials: S
authors.lastname: Jary
authors.forename: Frances
authors.initials: F
authors.lastname: Cowan
authors.forename: Marianne
authors.initials: M
authors.lastname: Thoresen
mesh_terms: D004569:Electroencephalography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: Hypothermia; Neonatal brain injury; Neonatal encephalopathy; Newborn; Outcome