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Passive cooling during transport of asphyxiated term newborns

Journal of Perinatology volume 33, pages 435–440 (2013)Cite this article

Subjects

Abstract

Objective:

To evaluate the efficacy and safety of passive cooling during transport of asphyxiated newborns.

Study Design:

Retrospective medical record review of newborns with perinatal asphyxia transported for hypothermia between July 2007 and June 2010.

Result:

Of 43 newborns transported, 27 were passively cooled without significant adverse events. Twenty (74%) passively cooled newborns arrived with temperature between 32.5 and 34.5 °C. One newborn arrived with a temperature <32.5, and 6 (22%) had temperatures >34.5 °C. Time from birth to hypothermia was significantly shorter among passively cooled newborns compared with newborns not cooled (215 vs 327 min, P<0.01), even though time from birth to admission to Boston Children’s Hospital was similar (252 vs 259 min, P=0.77). Time from birth to admission was the only significant predictor of increased time to reach target temperature (P=0.001).

Conclusion:

Exclusive passive cooling achieves significantly earlier initiation of effective hypothermia for asphyxiated newborns but should not delay transport for active cooling.

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References

  1. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 (9460): 663–670.

    PubMed  Google Scholar 

  2. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15): 1574–1584.

    Article  CAS  PubMed  Google Scholar 

  3. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361 (14): 1349–1358.

    Article  CAS  PubMed  Google Scholar 

  4. Simbruner G, Mittal RA, Rohlmann F, Muche R . Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126 (4): e771–e778.

    Article  PubMed  Google Scholar 

  5. Perlman JM . Summary proceedings from the neurology group on hypoxic-ischemic encephalopathy. Pediatrics 2006; 117 (3 Part 2): S28–S33.

    Article  PubMed  Google Scholar 

  6. Hoehn T, Hansmann G, Buhrer C, Simbruner G, Gunn AJ, Yager J et al. Therapeutic hypothermia in neonates. Review of current clinical data, ILCOR recommendations and suggestions for implementation in neonatal intensive care units. Resuscitation 2008; 78 (1): 7–12.

    Article  PubMed  Google Scholar 

  7. Gunn AJ, Hoehn T, Hansmann G, Buhrer C, Simbruner G, Yager J et al. Hypothermia: an evolving treatment for neonatal hypoxic ischemic encephalopathy. Pediatrics 2008; 121 (3): 648–649.

    Article  PubMed  Google Scholar 

  8. Wyatt JS, Edwards AD, Azzopardi D, Reynolds EO . Magnetic resonance and near infrared spectroscopy for investigation of perinatal hypoxic-ischaemic brain injury. Arch Dis Child 1989; 64 (7 Spec no.): 953–963.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Roth SC, Baudin J, Cady E, Johal K, Townsend JP, Wyatt JS et al. Relation of deranged neonatal cerebral oxidative metabolism with neurodevelopmental outcome and head circumference at 4 years. Dev Med Child Neurol 1997; 39 (11): 718–725.

    Article  CAS  PubMed  Google Scholar 

  10. Gunn AJ, Battin M, Gluckman PD, Gunn TR, Bennet L . Therapeutic hypothermia: from lab to NICU. J Perinat Med 2005; 33 (4): 340–346.

    Article  PubMed  Google Scholar 

  11. Gunn AJ, Gunn TR, de Haan HH, Williams CE, Gluckman PD . Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest 1997; 99 (2): 248–256.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gunn AJ, Gunn TR, Gunning MI, Williams CE, Gluckman PD . Neuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep. Pediatrics 1998; 102 (5): 1098–1106.

    Article  CAS  PubMed  Google Scholar 

  13. Gunn AJ, Bennet L, Gunning MI, Gluckman PD, Gunn TR . Cerebral hypothermia is not neuroprotective when started after postischemic seizures in fetal sheep. Pediatr Res 1999; 46 (3): 274–280.

    Article  CAS  PubMed  Google Scholar 

  14. Anderson ME, Longhofer TA, Phillips W, McRay DE . Passive cooling to initiate hypothermia for transported encephalopathic newborns. J Perinatol 2007; 27 (9): 592–593.

    Article  CAS  PubMed  Google Scholar 

  15. Hallberg B, Olson L, Bartocci M, Edqvist I, Blennow M . Passive induction of hypothermia during transport of asphyxiated infants: a risk of excessive cooling. Acta Paediatr 2009; 98 (6): 942–946.

    PubMed  Google Scholar 

  16. Fairchild K, Sokora D, Scott J, Zanelli S . Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU. J Perinatol 2010; 30 (5): 324–329.

    Article  CAS  PubMed  Google Scholar 

  17. Kendall GS, Kapetanakis A, Ratnavel N, Azzopardi D, Robertson NJ . On behalf of the Cooling on Retrieval Study G. Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2010; 95 (6): F408–F412.

    Article  PubMed  Google Scholar 

  18. Falzon A, Grech V, Caruana B, Magro A, Attard-Montalto S . How reliable is axillary temperature measurement? Acta Paediatr 2003; 92 (3): 309–313.

    Article  CAS  PubMed  Google Scholar 

  19. Morley CJ, Hewson PH, Thornton AJ, Cole TJ . Axillary and rectal temperature measurements in infants. Arch Dis Child 1992; 67 (1): 122–125.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. American Academy of Pediatrics. Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics 2010; 125 (2): 405–409.

    Article  Google Scholar 

  21. Frank JD, Brown S . Thermometers and rectal perforations in the neonate. Arch Dis Child 1978; 53 (10): 824–825.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Greenbaum EI, Carson M, Kincannon WN, O'Loughlin BJ . Rectal thermometer-induced pneumoperitoneum in the newborn. Report of two cases. Pediatrics 1969; 44 (4): 539–542.

    CAS  PubMed  Google Scholar 

  23. Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32 (1): 11–17.

    Article  PubMed  Google Scholar 

  24. Thoresen M . Supportive care during neuroprotective hypothermia in the term newborn: adverse effects and their prevention. Clin Perinatol 2008; 35 (4): 749–763.

    Article  PubMed  Google Scholar 

  25. Burnard ED, Cross KW . Rectal temperature in the newborn after birth asphyxia. Br Med J 1958; 2 (5106): 1197–1199.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dahm LS, James LS . Newborn temperature and calculated heat loss in the delivery room. Pediatrics 1972; 49 (4): 504–513.

    CAS  PubMed  Google Scholar 

  27. Johnston ED, Becher JC, Mitchell AP, Stenson BJ . Provision of servo-controlled cooling during neonatal transport. Arch Dis Child Fetal Neonatal Ed 2012; 97 (5): F365–F367.

    Article  PubMed  Google Scholar 

  28. Craig JV, Lancaster GA, Williamson PR, Smyth RL . Temperature measured at the axilla compared with rectum in children and young people: systematic review. BMJ 2000; 320 (7243): 1174–1178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported in part by a grant from the Charles H Hood Foundation. We thank Shaye Moore and Elizabeth Jarvis for their assistance with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    D O'Reilly & A Hansen

  2. Critical Care and Cardiovascular Program, Boston Children’s Hospital, Boston, MA, USA

    M Labrecque

  3. Critical Care Transport Team, Boston Children’s Hospital, Boston, MA, USA

    M O'Melia

  4. Clinical Research Program, Boston Children’s Hospital, Boston, MA, USA

    J Bacic

  5. Department of Neurology, Fetal-Neonatal Neurology Program, Boston Children’s Hospital, Boston, MA, USA

    J S Soul

Authors
  1. D O'Reilly
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  2. M Labrecque
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  3. M O'Melia
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  4. J Bacic
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  5. A Hansen
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  6. J S Soul
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Corresponding author

Correspondence to J S Soul.

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O'Reilly, D., Labrecque, M., O'Melia, M. et al. Passive cooling during transport of asphyxiated term newborns. J Perinatol 33, 435–440 (2013). https://doi.org/10.1038/jp.2012.138

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