2. Review the resuscitation and NICU
admission/stay of Baby Girl M
Discuss criteria for therapeutic hypothermia
Review hypoxic-ischemic encephalopathy
(HIE)
Discuss goals of treatment for infants with
HIE
3. Maternal history
◦ Evaluated in triage x 2 on 5/21 for bleeding but
discharged home undelivered
◦ Seen in OB office on 5/22 for routine visit
decreased heart tones
◦ Admitted to MHSB
◦ C-section for non-reassuring fetal status
◦ 23 minutes from arrival to OB floor to delivery of
infant
4. C-section for non-reassuring fetal status
Complete abruption
Apgars 1 – 2- 5
◦ Occasional gasps at delivery
◦ Initial heart rate ~20
◦ Given PPV to improve heart rate but gasping
respirations continue
◦ Intubated at 7 minutes of age
◦ At 10 minutes of age was having more spontaneous
respirations but apgar score was 5 so passive
cooling initiated
8. Neuroprotective
Current treatment of choice to reduce brain
injury and improve long-term outcomes for
neonates with HIE
9. Current criteria for cooling does not capture
all infants with brain injury
Close and repetitive clinical assessment
required
10. ◦ Fetal bradycardia
◦ Complete placental
abruption
◦ Cord pH of 6.54 and
base deficit of -25
◦ Apgar of 5 at 10
minutes of age
◦ Required intubation in
delivery room
11. Passive cooling continues
CPAP per ETT
Placement of umbilical venous catheter
VBG: pH 7.13 and base deficit -20
Started on aEEG
Clinical presentation
Total body cooling began at ~90 minutes of
age
12. Respiratory management
◦ Attempt to maintain normal blood gas values
Circulatory
◦ Decreased cardiac output
◦ Maintain arterial blood pressure 40-60 mmHg
Fluid/Electrolyte/Nutrition
◦ Fluid restriction
◦ Monitor electrolytes every 8-12 hr
◦ Glucose
◦ Delayed feedings
Renal
◦ Follow serum creatinine rather than urinary output
13. Hematologic
◦ Increase in nucleated RBCs
◦ Prolonged coagulation/DIC
◦ Low platelet counts
Infection Control
Stress/Pain management
◦ Provide optimal sedation and analgesia during
cooling
Skin
◦ Skin lesions
◦ Subcutanous fat necrosis
14. Treat seizures
◦ aEEG
◦ Phenobarbital is first line of treatment
◦ Can be difficult to treat
◦ May need to consult neurology
Neuroimaging
◦ MRI
Educate/support family
15. Continuous pattern on aEEG at 4 hours of age
Metabolic acidosis normalized
Day 1: mild abnormalities in liver functions,
good renal function and extubated
Day 2: improved liver functions, off CPAP
Day 3: sleep-wake cycling on aEEG
Day 4: rewarmed
Day 10: MRI and discharge to home
16. Ahearne, C., Boylan, G., & Murray, D. Short and
long term prognosis in perinatal asphyxia: an
update. (2013) World Journal of Clinical Pediatrics
5 (1), 67-74.
Natarajan, G., et al. (2013). Apgar scores at 10
minutes and outcomes at 6-7 years following
hypoxic-ischaemic encephalopathy. Archives of
Disease in Childhood: Fetal and Neonatal edition
98(6), F473-479.
Pappas, A., et al. (2014). Cognitive outcomes
after neonatal encephalopathy. Pediatrics 135 3),
e624-634.
17. Robertson, C. & Perlman, M. (2006). Follow-up of
the term infant after hypoxic-ischemic
encephalopathy. Paediatrics & Child Health 11
(5), 278-282.
Shankaran, S., et al. (2012). Childhood outcomes
after hypothermia for neonatal encephalopathy.
New England Journal of Medicine 366 (22), 2085-
2092.
van Laerhoven, H., de Haan, T., Offringa, M.,
Post, B., & van der Lee, J. (2013). Pediatrics 131
(1), 88-98.
Verklan, M.T., & Walden, M. (2010). Core
curriculum for Neonatal Intensive Care Nursing
(4th ed). St. Louis: Saunders.
