This document summarizes the therapeutic hypothermia protocol for treating hypoxic ischemic encephalopathy (HIE) in infants at the OU Children's Neonatal Intensive Care Unit (NICU). The protocol aims to cool infants to a target core temperature of 33.0-34.0°C to prevent or reduce neurologic injury from HIE. The summary describes the criteria for initiating cooling, equipment used, monitoring and charting procedures, rewarming process, and training for nurses on the therapeutic hypothermia team.

1. Subspecialty Nursing within
the NICU
Therapeutic Hypothermia for
Hypoxic Ischemic Encephalopathy
John W. Karlin, RNC-NIC, CQPA
MSI Certified Team Supervisor
Team Leader, NICU Therapeutic Hypothermia Team
OU Children’s Neonatal Intensive Care

2. Disclosures
I have nothing to disclose.

3. Purpose & Policy
Therapeutic Hypothermia
for the treatment of
moderate to severe Hypoxic
Ischemic Encephalopathy
(HIE) for cooling with mild
systemic hypothermia (core
temp 33.0 – 34.0C) to
prevent or reduce the
severity of neurologic injury
associated with HIE.
33.0 C 33.5 C 34.0 C
Target Core Temperature

4. Criteria

5. Criteria

6. Criteria

7. Criteria met; lets Be Cool!
 Passive cooling initiated until controlled cooling equipment
is available.
 Window of opportunity is 6 hours from time of birth; the sooner
the infant is on cooling equipment, the better.
 Minimize delays as much as possible.
 Infant will become vasoconstricted with lower core temperature,
making IV access a challenge; obtain IV access ASAP.
Copyrighted photo
of John Travolta
in “Be Cool” 2005


8. Equipment
We are currently using:
 3 MTRE Criticools
 1 Olympic Brainz Monitor
 1 Olympic CFM 6000
https://youtu.be/AegRDBY7rTo

9. Simple,right? Two sizes of whole body wraps:
< 4kg & > 4kg.
Informing the admitting RN is
helpful to reduce waste.
Reorder Kanban is on the 3rd to
last wrap in supply.
aEEG Needles placed subdural
to minimize signal impedance,
or gel electrodes used when
application of needles is not
desirable. Reorder Kanban also
in place for electrode supplies.
* Temp probe
connections will be
different based on
which machine is being
used. Hard Poka-Yoke
* Improper electrode
placement or loose
ground lead will
result in a different
reading.

10. Charting Initial Info. Sheet: To help
keep track of admissions &
provide basic info for
statistical data.
Paper Flowsheet:
Temperatures & basic notes.
CribNotes: Temperatures, etc.
CFM/aEEG: Markers for
anything that would affect the
reading: assessment, BP,
glucose, events, etc.

11. Rewarming&FurtherTesting  Rewarming is done
slowly over 8 hours.
 Temp increased by
0.2C every 30min
until 36.5C.
Watch for
electrolyte changes,
seizures, & changes
in aEEG.
 Infant is 1:1 during
1st & last 8 hours
due to potential
instability.
Data: Initially you will only
have your physical assessment
& CFM/aEEG. Once warm,
expect HUS, EEG & MRI.
P.A.
CFM
HUS
EEGMRI

12. Training Application process to Therapeutic Hypothermia Team,
selection by NICU Management.
New team members go through:
1. 4 hr. A&P class w/ intro. to equipment & charting.
2. Individual 1:1 equipment review.
3. Three 30min aEEG in-service online at Natus.
4. Healthstream: Neonatal Seizures.
5. Five online training courses at Neonatal Care Academy.
6. Final checkoff on process & equipment.

13. That’s it in 10min. Questions?
More info. is in the cooling reference 3-ring binder.
This brief presentation is on Slideshare.
John Karlin, RNC-NIC, CQPA
MSI Certified Team Supervisor
NICU Therapeutic Hypothermia Team
OU Children’s NICU
John.Karlin@OKState.edu
Proud member of the
American Society for Quality