The safety of passive hypothermia during assessment for hypoxic ischaemic encephalopathy

Abstract

IntroductionHypoxic ischaemic encephalopathy (HIE) is poorly predicted by markers of hypoxic ischaemic (HI) delivery. Repeated examination of infants with HI markers facilitates diagnostic certainty of HIE severity. When infants with HIE are nursed at incubator ambient air-temperature set to achieve normothermia, there is sometimes associated hyperthermia, a predictor of poor outcome. An alternative is to nurse infants without external heat (passive hypothermia, PH). We report a retrospective cohort-study to determine the safety of PH during the assessment of infant eligibility for therapeutic hypothermia (TH). MethodsInborn infants of gestational age ≥36 weeks, less than 6 h of age, with evidence of HI delivery were admitted for assessment for HIE. Infants were nursed undressed in an incubator treated with PH and underwent serial neurological examinations to determine eligibility for TH. Body temperature was monitored but no targeted temperature was set. Safety outcomes during PH were: minimum and maximum temperatures, minimum and maximum glucose recordings, time to onset of TH, platelet count, maximum and minimum blood glucose concentration. Results26 infants with median gestational age of 39 weeks, median birth weight of 3.30 kg underwent PH for a median duration of 4 h 19 min. During PH the median minimum and maximum temperatures recorded were 35.9 °C and 36.7 °C, the median minimum glucose was 4.6 mmol/L. Fourteen infants were eligible for TH and target temperature was achieved at median age of 4 h. ConclusionPH is not associated with adverse safety outcomes and without delaying achieving TH target-temperature.