Brochure - Associates in Newborn Medicine

About Mild Systemic Hypothermia (MSH)• The goal of MSH is to cool the core body temperature in a rangebetween 33.5-34.5 C for 72 hours, beginning as soon as possiblefollowing successful resuscitation.• Cooling can be achieved by using either a cooling blanket(whole-body cooling), or a cooling cap (selective head cooling).Both systems have been reviewed by the Federal DrugAdministration and have been shown effective in improvingoutcomes for infants experiencing HIE.Preparing a Baby With HIE for TransportA.Passively cool the baby as directed:– Turn off the overhead radiant warmer– Check the infant’s rectal temperature every 30 minutes– Place a blanket on the infant only when the infant’s temperature dropsto 35 C rectally– Continue to check the infants temperature every 30 minutes– Do not let the infant’s temperature drop below 35 C rectallyMild SystemicHypothermiaAt Children’s Hospitals and Clinics of MinnesotaChildren’s Hospitals and Clinics of Minnesota provides Mild SystemicHypothermia (MSH), or body cooling therapy for infants affectedby Hypoxic-ischemic Encephalopathy (HIE)—damage to cells in thecentral nervous system (the brain and spinal cord) from inadequateoxygen. The therapy prevents or reduces the severity of neurologicalinjury and improves functional outcomes for infants.Hypothermia, achieved by selective head cooling or whole-bodycooling, is a new technique based on research demonstratingreductions in brain injury following HIE.• Published research indicates that the sooner cooling therapyis started in HIE infants, the more likely it will effectivelyimprove outcomes.• After cooling therapy has been administered for more than72 hours, the patient will undergo gradual re-warming at no morethan 0.5 C per hour during the subsequent four to six hours.Infant Care During Cooling Therapy• During the initial cooling phase—before the infant reaches thetarget body temperature—nothing is placed between the babyand the cooling system and the infant wears only a diaper.• Once the infant reaches the targeted temperature range,33.5-34.5 C, a sheet may be placed between the baby andthe cooling system. A cloth diaper may also be placed underthe infant’s head for comfort.B.Continue discussion with NICU staff for ongoing managementCollaborating With Regional Care ProvidersChildren’s neonatal team members work closely with referring hospitals to coordinatesafe and timely infant transports. We work with referring providers to ensure the bestpossible care until transport occurs, and provide detailed status updates on all infantreferrals. When the transport team arrives:• The family will be asked to give permission to Children’s staff to share informationwith the referring hospital staff.• Providers can receive updates from Children’s neonatologists by calling:Children’s - St. Paul NICU: (651) 220-6210Children’s - Minneapolis NICU: (612) 813-6295About Perinatal Asphyxia And Hypoxic-Ischemic Encephalopathy (HIE)• Hypoxic-ischemic events that occur around the time of birth mayresult in brain injury called encephalopathy.• At birth, these infants usually have a need for resuscitationand experience neurological depression, seizures, andelectroencephalographic abnormalities.• They have an increased risk of death or neuro-developmentalabnormalities later in infancy if the encephalopathy seen at birthis severe.• Recent randomized trials in full-term and near full-term newbornssuggest that treatment with MSH is safe and may improve survivalwithout disabilities up to 18 months of age, but long-term efficacyand safety are yet to be established.Mild Systemic Hypothermia is a standard of care at most Level IIIneonatal centers. Children’s was the first in the state to offer MSHtreatment. Today, our combination of experience and expert subspecialists—includingneurologists, neurosurgeons, hematologists, andoncologists—work together to provide the best in cooling therapy toprevent or reduce the severity of neurologic injury associated with HIE.

Patient Eligibility Criteriafor TherapyA. Infant must be > 36 weeks gestational age, >1,800B.grams, and must have at least one of the following:– Apgar score of < 5 at 10 minutes after birth– Continued need for resuscitation, includingendotracheal or mask ventilation, at 10 minutesafter birth– Acidosis defined as either umbilical cord pH orany arterial pH within 60 minutes of birth < 7.0– Base Deficit > 16 mmol/L from cord or otherinfant blood sample within 60 minutes of birthInfant must have seizures, or alternatively, moderateto severe encephalopathy, defined by an alteredstate of consciousness, with at least three of thefollowing (see chart on the right):Moderate to Severe EncephalopathyCategory Moderate Encephalopathy Severe Encephalopathy1. Level of consciousness Lethargic Stupor or coma2. Spontaneous activity Decreased activity No activity3. Posture Distal flexion, complete extension Decerebrate4. Tone Hypotonia (focal or general) Flaccid5. Primitive reflexesSuck Weak AbsentMoro Incomplete Absent6. Autonomic systemPupils Constricted Deviated, dilated, or non-reactive to lightHeart rate Bradycardia VariableRespiration Periodic breathing ApneaN Engl J Med 2005; 353: 1574-84exclusion criteriaExclusion criteria includes:• Birth weight < 1,800 grams• Gestational age < 36 weeks• Condition deemed incompatible with survival• Inability to initiate cooling within six hours of birth• Presence of known major congenital anomalies or recognizedchromosomal abnormalitiesPotential Harmful Effects of Cooling• MSH has been shown as a safe, effective therapy in randomizedcontrolled trials where the targeted core body temperatureranged between 33.5-34.5 C.• No harmful side effects, with the exception of occasional benignslowing of the heart rate, were observed in these trials.• Cooling below a core temperature of 32 C may produceimpairment of heart functions and other problems, includingneutropenia, thrombocytopenia, and hypokalemia.Cooling should be started no laterthan six hours after birth.Therapy should be started as soonas the infant is deemed eligible.If you are unsure whether a baby qualifies for therapy, please callthe NICU at Children’s immediately for consultation.• Children’s - St. Paul NICU: (651) 220-6650• Children’s - Minneapolis NICU: (612) 813-6295