Perinatal asphyxia is an insult to the fetus or the newborn due to lack of oxygen (hypoxia) and or a lack of perfusion (ischemia) to various organs. Hypoxia ischemia remains a significant cause of neonatal mortality and morbidity and adverse neurodevelopmental outcome. Therapeutic hypothermia found to improve neurodevelopmental outcome in asphyxiated babies.
Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathyMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathyMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Thermoregulation in neonates, or newborn infants, is a critical aspect of their care and well-being. Neonates have limited ability to regulate their body temperature compared to older children and adults. They are highly susceptible to heat loss and have a greater risk of developing hypothermia, which can have detrimental effects on their health.
Several factors contribute to the challenges of thermoregulation in neonates. Firstly, their body surface area-to-weight ratio is higher than that of adults, making them more vulnerable to heat loss. Additionally, neonates have thinner skin and less insulating subcutaneous fat, reducing their ability to retain heat. Their immature nervous systems and limited ability to shiver further complicate their temperature regulation capabilities.
To support thermoregulation in neonates, various measures are taken in clinical settings. Immediately after birth, drying the baby and placing them under a radiant warmer or on a warm, dry surface helps to prevent heat loss. Skin-to-skin contact with the mother, also known as kangaroo care, provides warmth and promotes bonding while stabilizing the infant's temperature.
The use of warm clothing, hats, and swaddling blankets assists in reducing heat loss through evaporation and conduction. Incubators and heated cribs maintain a controlled environment to prevent temperature fluctuations. Additionally, monitoring the infant's temperature regularly and adjusting the ambient temperature as needed are crucial for maintaining their thermal stability.
Preventing overheating is equally important, as excessive warmth can lead to hyperthermia. It is essential to avoid excessive clothing or covering that could cause the baby to overheat.
Ensuring a suitable ambient temperature, promoting skin-to-skin contact, and providing appropriate clothing and thermal support are vital components of neonatal care to maintain a stable body temperature. By carefully managing thermoregulation, healthcare professionals can help optimize the well-being and development of newborn infants.
Thermoregulation in neonates, or newborn infants, is a critical aspect of their care and well-being. Neonates have limited ability to regulate their body temperature compared to older children and adults. They are highly susceptible to heat loss and have a greater risk of developing hypothermia, which can have detrimental effects on their health.
Several factors contribute to the challenges of thermoregulation in neonates. Firstly, their body surface area-to-weight ratio is higher than that of adults, making them more vulnerable to heat loss. Additionally, neonates have thinner skin and less insulating subcutaneous fat, reducing their ability to retain heat. Their immature nervous systems and limited ability to shiver further complicate their temperature regulation capabilities.
To support thermoregulation in neonates, various measures are taken in clinical settings. Immediately after birth, drying the baby and placing them under a radiant warmer or on a warm, dry surface helps to prevent heat loss. Skin-to-skin contact with the mother, also known as kangaroo care, provides warmth and promotes bonding while stabilizing the infant's temperature.
The use of warm clothing, hats, and swaddling blankets assists in reducing heat loss through evaporation and conduction. Incubators and heated cribs maintain a controlled environment to prevent temperature fluctuations. Additionally, monitoring the infant's temperature regularly and adjusting the ambient temperature as needed are crucial for maintaining their thermal stability.
Preventing overheating is equally important, as excessive warmth can lead to hyperthermia. It is essential to avoid excessive clothing or covering that could cause the baby to overheat.
Ensuring a suitable ambient temperature, promoting skin-to-skin contact, and providing appropriate clothing and thermal support are vital components of neonatal care to maintain a stable body temperature. By carefully managing thermoregulation, healthcare professionals can help optimize the well-being and development of newborn infants.
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
NEONATAL HYPOTHERMIA PAEDIATRICS BY DR. PARTHASARATHYSamDilipPrasanth1
The World Health Organization (WHO) defines
neonatal hypothermia as an axillary temperature
below 36.5°C (97.7°F) among newborns aged
below 28 days.
Normal axillary temperature is
36.5–37.5°C
Severity Of Hypothermia
1)Mild hypothermia/cold stress 36.0–36.4°C
2)Moderate hypothermia 32.0–35.9°C
3)Severe hypothermia <32°C.
It is an environmental temperature at which the newborn has minimal
rates of oxygen consumption and expends the least energy to maintain
its temperature is needed.
Mechanism Of Heat Production in
Newborn
1)Nonshivering thermogenesis—occurs by utilizing brown fat in
newborns. Thermoreceptors on sensing a low temperature result in
elevated sympathetic output and this stimulates the beta-adrenergic
receptors in the brown fat increasing cAMP. This results in
increased metabolism and increases heat production.
2) Increased metabolic activity—the brain, heart, and liver produce
metabolic energy by oxidative metabolism of glucose, fat, and
protein.
3)Peripheral vasoconstriction—reduces blood flow to the skin and
decreases loss of heat.
MECHANISM OF HEAT LOSS IN NEWBORN
Evaporation
Radiation
Due to the
evaporation of
amniotic fluid
from skin surface
Conduction
By coming in
contact with
cold objects
such as cloth
and weighing
tray
Convection
Convection by
air currents
where cold air
replaces warm
air around baby
due
to open windows,
fans, etc.
Radiation to
colder solid
objects in
vicinity-like
walls
Risk Factors
PRETERM,
LBW,IUGR,Asphyxia
Congenital
Abdominal Wall
defects
Low delivery room
temperature, Bathing
the baby after
delivery
Removal of vernix
caseosa, Reduced
contact with mother
Delayed initiation of
breastfeed
Surgical procedures
PREVENTION OF HYPOTHERMIA IN VARIOUS
SETUPS
Memories flashed across my
mind as I came
across the first photo
of myself as a little
baby..
In delivery room and operation theater:
• Follow the 10 steps of “warm chain” recommended by the WHO.
Draught free and warm delivery room temperature of 25–28°C.
Radiant warmer to be prewarmed along with all the linen and clothes/cap before
delivery.
Cap prevents significant heat loss in preterm as well as in term infants. Remove wet towel.
Baby is placed directly on the mother’s abdomen or chest after delivery in both vaginal
and cesarean delivery.
Provide warmth by skin-to-skin contact after drying with a warm and dry linen if baby
is doing well.
Breastfeeding can be started immediately and the baby and the mother are covered
with a warm blanket. Delay bathing. No bathing in the hospital.
Resuscitation, if required, should be done under the radiant warmer and heated
humidified gases to be used if oxygen or positive pressure ventilation is required.
Prewarm medications and intravenous (IV) fluid, if required.
During surgery, abdominal organ coverage reduces the incidence of hypothermia.
Additional measures for very preterm infants (who are more prone to hypothermia due
to greater surface-to-mass ratio and lesser brown fat):
In the NICU:
• Use servocontrolled warmer or
How to first aid high fever.
Understanding the mechanism regulation of body temperature
FIRDT AID FEVER method
• TEPID SPONGING PROCEDURE
• ANTIPYRETIC DRUG
Definiting FEVER
Understanding What is the role of FEVER and Why HIGH FEVER must
be first aid
Impact of Positioning on Neonate with Respiratory Distress: Supine Vs ProneSyed Kamrul Hasan
prone positioning improves oxygenation in neonates with respiratory distress and improves signs of respiratory distress thereby leading to easier management and reduced requisite of oxygen particularly in resource limitation environment of most public sector hospitals. Moreover, it is simple to use, low-cost and doesn't need any special training.
About 10% of all newborn require some assistance to begin breathing after birth, and 1% require extensive resuscitation efforts. Newborn resuscitation cannot always be anticipated in time to transfer the mother before delivery to a facility with specialized neonatal support. Therefore, every hospital with a delivery suite should have an organized, skilled resuscitation team and appropriate equipments available.
Surfactant is a surface acting material or agent that is responsible for lowering the surface tension of a fluid. Surfactant that lines the epithelium of the alveoli in lung is known as pulmonary surfactant & is decreases the surface tension on the alveolar membrane.
Presented by Dr. Samad
Bronchopulmonary dysplasia is a pathologic process leading to signs and symptoms of chronic lung disease that originates in the neonatal period.
Presented by Dr. Tahir
Pneumothorax is one of the most common air leak syndromes that occurs more frequently in the neonatal period than in any other period of life and is a life-threatening condition associated with a high incidence of morbidity and mortality.
Presented by Dr. Rupom
respiratory difficulty commonly in a preterm neonate and is due to deficiency of pulmonary surfactant. It was formerly known as Hyaline Membrane Disease (HMD).
presented by Dr. Taher
ABG test measures the blood gas tension values of the arterial partial pressure of oxygen, and the arterial partial pressure of carbon dioxide, and the blood's pH
Nephrotic syndrome is a clinical state characterized by : Massive proteinuria ( > 40 mg /m²/hour), Hypoalbuminaemia ( < 2.5 gm/dl), Generalized edema, Hyperlipidemia ( S. cholesterol >250 mg /dl). 60%-80% present before 6 years. MCNS most commonest type of nephrotic syndrome , about 85% of idiopathic nephrotic syndrome.
Among blood group incompatibility more than 95% are caused by ABO and Rh blood type. Remaining less than 5% are caused by Duffy, Lewis , Kidd and other minor blood group.
ABO incompatibility are more common, less severe but Rh incompatibility are less common, more severe.
most common congenital cyanotic heart disease.one of the conotruncal family of heart lesions.. It accounts for 7 to 10% of all congenital heart abnormalities.
Corona virus was first identified as a cause of the common cold in 1960. Until 2002, the virus was considered a relatively simple, nonfatal virus.Over the last three decades there have been three attacks of three different coronaviruses, SARS-CoV, MERS CoV and the recent one 2019 novel coronavirus (2019-nCoV).
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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The four main behavioral effects of AUD are impaired control over
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effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
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Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Neonatal Therapeutic Hypothermia.pptx
1.
2. PRESENTED BY
DR. SYED KAMRUL HASAN
MEDICAL OFFICER
NEONATAL INTENSIVE CARE UNIT
SWMCH, SYLHET
3. Introduction
Perinatal asphyxia is an insult to the fetus or the
newborn due to lack of oxygen (hypoxia) and or a
lack of perfusion (ischemia) to various organs.
Hypoxia ischemia remains a significant cause of
neonatal mortality and morbidity and adverse
neurodevelopmental outcome. Therapeutic
hypothermia found to improve neurodevelopmental
outcome in asphyxiated babies.
4.
5. History of Therapeutic Hypothermia
• Hippocrates use snow and ice packing to reduce
haemorrhage in the wound.
• In 1800s Russian patient’s with arrest would be
covered in snow with the hopes of return of
spontaneous circulation.
• Napoleon’s Forces used it for the preservation of
amputated limbs.
6. • In 1937 Fay cooled a patient to 32°c to prevent
cancer cells from spreading.
• In 1959 it was being used for CNS injury.
• Up to 1980’s concept of therapeutic hypothermia
using in cardiac arrest and traumatic brain injury in
adults probable benefit in neurological outcome.
7. • Marianne Thoresen (Researcher on cerebral
perfusion) Intrigued by stories of children who fell
through norwegian ice and suffered prolonged
drowning in iced water emerged with preserved
cerebral function.
• Data from animal study show beneficial effect.
• In 2000s using evidence based practice from prior
researcher trials.
8. Mechanism of Hypoxic Ischemic
Encephalopathy (HIE)
In Hypoxic Ischemic Encephalopathy (HIE) biphasic
nature of cell death occurs. Primary neuronal death
(cell hypoxia/ Primary energy failure) followed by
latent period at least 6 hours than secondary phase
or delayed neuronal death (secondary energy failure)
begins. So therapeutic window of 6 hours.
9. Mechanism of Ischemic Brain Injury
Hypoxia
Ischemia
Primary
Neuronal
Death
Cytotoxic
Mechanism
Delayed
Neuronal
Death
Birth 1 hour 6 hours Days
Hypothermia
10. Secondary Energy Failure
Hypoxia-ischemia
Anaerobic Glycolysis
Decrease ATP
Adenosin Increase Glutamate Increase Lactate
Hypoxanthine Increase intracellular calcium
activates lipases
Xanthine
Increase FFA activate NOs
Free radicals free radicals NO
Xanthin
oxidase
11. How Hypothermia prevent HIE damage
• Decrease cerebral blood flow and thus decrease
metabolic rate of brain.
• Slows depolarization of brain cells.
• Decrease accumulation of excitatory neurotransmitters.
• Decrease release of free radicals.
• Keeps integrity of brain cell membrane.
• Decrease apoptosis.
12. Types of Therapeutic Hypothermia
1. Selective head cooling.
Example: Olympic cool cap
2. Whole body cooling.
Example: Tecotherm, Blaketrol,
Phase changing materials (Miracradle)
13. Candidate for Therapeutic Hypothermia
Infants ≥36 weeks gestation, birth weight ≥1800gm
with at least one of the following:
• Apgar Score of 5 or less at 10 minutes after birth
• Need for assisted ventilation including endotracheal
or bag mask ventilation at 10 minutes after birth.
• Acidosis PH<7, Base deficit >16mmol/L or more
within 1 hour of birth.
And
• Moderate to severe encephalopathy or seizure
(clinical or electrical)
14. Newborn infants ≥36 weeks gestation and birth weight ≥1800gm
Meet both Physiologic and Neurologic criteria,
Physiologic Criteria
Cord or baby ABG <1 hour
No gas <1 hour
Or
PH 7.01-7.15 or BD 10-15.9
A major perinatal event : cord
prolapsed, uterine rupture
And
APGAR Score <5 at 10 minutes
Or PPV ≥10 minutes
PH≤7
or
BD≥16
Meet
Physiologic
Criteria
Cooling
Plus
Neurologic Criteria
Moderate Encephalopathy
3 of 6
Severe Encephalopathy
3 of 6
seizure
(clinical or
electrical)
Meet
Neurologic
Criteria
AND
Or
Or
15. Criteria for defining moderate & severe encephalopathy
(modified Sarnat’s staging)
Category Moderate Encephalopathy Severe Encephalopathy
1. Level of Consciousness Lethargic Stupor or coma
2. Spontaneous activity Decrease No activity
3. Posture Distal flexion
Complete extension
Decerebrate
4. Tone Hypotonia Flaccid
5. Primitive reflexes
Suck weak absent
Moro Incomplete absent
6.Autonomic system
Pupils Constricted Deviated, dilated or
nonreactive to light
Heart rate Bradycardia variable
Respiration Periodic breathing Apnoea
16. Contraindication of Therapeutic Hypothermia
• The baby appears moribund
• Severe ongoing hypoxaemia
• Severe coagulopathy or evidence of bleeding
• Major congenital or genetic abnormalities
• PPHN
• Intracranial Haemorrhage
• Shock which is catecholamine resistant
18. Prerequisites
Prior to initiating Therapeutic hypothermia:
• A written informed consent from parents/ legal guardian.
• The neonate’s cardio-respiratory status should be stable.
• Patient in NICU.
• Access to bedside USG, CT, MRI, EEG.
• Have 1:1 nurse: patient ratio if non servo controlled
devices.
• Secure at least 2 intravenous line.
19. Preferred Method of Providing TH
• Servo- controlled devices ( head cooling, Whole
body cooling) are to be preferred to non servo
controlled device ( ice gels & phase change material
devices).
• Whole body cooling preferred to selective head
cooling.
26. Procedure
• Confirm eligibility for hypothermia therapy.
• Gather equipment require for the procedure.
• Pre cool the blanket to 5°c for whole body cooling to
maintain an esophageal or rectal temperature of
33.5°c ± 0.5°c.Lay infant supine on the precooled
mattress with occiput resting on the mattress. A single
layer thin blanket may be placed between the infant
and the cooling mattress to prevent soiling of
equipment.
27. • Insert the esophageal temperature probe into an
external naris. Probe should be positioned in the lower
third of the esophagus ( desired length = distance from
nares to ear to the mid sternum minus 2 cm). Secure
the probe by adhesive tap to the side of the nose.
Connect the probe to the cooling unit. Confirm probe
placement with a radiograph. In case of Rectal
temperature sensor measure and mark the sensor,
lubricate the tip, insert the rectal probe 5 to 6 cm into
the rectum, and secure to the buttocks with tape.
28. • Use an open radiant warmer bed for optimal
monitoring. Skin temperature will be monitored by
skin temperature probe on the lower abdomen
attached to the radiant warmer. The radiant warmer is
on manual mode with the heat turned off.
• Operate the cooling unit in automatic mode with a
core temperature goal of 33.5°c ± 0.5°c
29. • The infant’s esophageal or rectal temperature will
begin to decrease soon after the initiation of the
cooling therapy. The cooling system adjust
automatically to achieve 33.5°c by approximately 90 to
120 minutes. Temperature should not fluctuate more
than ±0.5°c . Total period of cooling 72 hours.
31. • Gradual rewarming is done over 6 hours after
completion of 72 hour cooling period. At a rate of
0.5°c/hour over 6 to 10 hours up to maximum set
point of 36.5°c.
• When normothermia is achieved, turn off hyper-
hypothermia unit and remove cooling mattress and
probe.
32. • During the cooling and rewarming process monitor and
record esophageal/rectal, skin and water temperature
as well as vital signs HR,RR,BP, Spo2, urine output at
regular intervals. Daily review for evidence of infection.
• Blood investigation: RBS, ABG, S.Electrolyte, LFT, CBC,
Coagulation profile.
33. Supportive care during TH
• Sedative/ Analgesic: Morphine/Fentanyl
• Enteral feed : Minimal enteral feeding if
hemodynamically stable.
• No prophylactic antibiotic
• AED: if convulsion present clinical or electrical
• Platelet transfusion: if platelet count <1lac.
36. Phase Changing Materials
• PCMs are passive heating and cooling substances,
usually made of a salt hydride, fatty acid and ester or
paraffin such as octadene.
• PCMs are solid at room temperature but when in
contact with warmer objects they liquefy and absorb
and store heat.
• Liquid PCMs can solidify and give off heat.
• Temperature Monitoring required additional blanket
if low temperature, or additional PCM if temperature
high outside therapeutic range.
40. Temperature maintenance in Miracradle
• Rectal temperature >33.8°c : Introduce FS 21 PCM
• Temperature <33.2°c: Introduce folded piece of cloth
under the newborn and cover the baby.
• Switch on warmer in manual mode and grade up the
temperature up to 10-20%.
41. Do’s & Don’ts in Miracradle
• Do not keep FS 21 & FS 29 in deep freezer.
• Avoid direct contact of PCM with the newborn.
• Do not bend/ distort or fold.
• Once a month cross check the temperature on the
charged FS 21 & 29.
• For cleaning the surface soap water solution,
isopropyl alcohol or any other new born friendly
cleaning solution.
• Sanitize before and after each use.
42. Frozen Ice Gel Packs
Equipments:
• 4 cold packs in fridge
temperature at 10°C
• Disposable rectal probe and
cable
• Cotton cover the cold packs
43. Temperature maintenance in Frozen Ice Gel Packs
Temperature
Ranges
Number of cold
packs applied
Area to be applied
>37°C 4 Head, Shoulders ,Neck,
Trunk
36.1°C-37°C 3 Shoulders, Neck, Trunk
35.1°C-36°C 2 Shoulders, Trunk
34.1°C-35°C 1 Trunk
33°C-34°C 0 Nil
44. Advantage of Therapeutic Hypothermia
• Therapeutic hypothermia is now the gold standard
treatment for infants with moderate to severe
Hypoxic Ischemic Encephalopathy (HIE).
• Therapeutic hypothermia reduce the mortality and
morbidity.
• Improve the Neurodevelopmental outcome at 18 -24
months about 24% compare to baby who are not
undergoes therapeutic hypothermia.
47. TOBY Trial
The TOBY trial based in the UK during 2007 using
Tecotherm Neo. Result shows cooling increases
infants chance of surviving without neurological
deficits at 18 months and reduces
neurodevelopmental impairment in survival.
48. Deficiencies in evidences
• Long term neurological outcome at 18 months early
to diagnosed CP and cognitive deficiency.
• Best method of temperature monitoring rectal
versus esophageal.
• Does temperature fluctuations causes any adverse
outcome.
49. Reference
• Neonatology Management , Procedure, On call
Problems, Diseases and drugs- Tricia Lacy Gomella 8th
Edition.
• The Science of Paediatrics – Dr. Tom Lissaure
• Illustrated Textbook of Paediatrics- 6th Edition
• New England Journal of Medicine.
• AIIMS Protocol in Neonatology-2nd Edition
50. • The LANCET Global Health.
• https://pubmed.ncbi.nlm.nih.gov/24982721/
• www.resarchgate.net
• https://thejns.org/view/journals/j-
neurosurg/130/3/article-p1006.xml
• https://www.frontiersin.org/articles/10.3389/fnins.
2019.00586/full