Therapeutic hypothermia in neonatal intensive care unit: Challenges and practical points
Therapeutic hypothermia (TH) is used for hypoxic ischemic encephalopathy (HIE) of the term or near term newborns to reduce the possible neurological handicap. The aim of this review is to focus on monitorization and management of newborns undergoing TH in Neonatal Intensive Care Unit. MEDLINE search was performed with keywords "therapeutic hypothermia, newborn." Articles on human subjects published between 2004 and 2015 were included. TH is defined as moderate hypothermia where the core body temperature measured by the esophageal or rectal probe is cooled down to 33.0 35degC for 72 h. It may be administered by selective head cooling or with total body cooling methods by using a variety of different devices. TH is suggested to be used within certain guidelines in newborns with moderate to severe HIE meeting definitive criteria. For best results treatment needs to be started no later than 6 h of life which at times may be challenging for the clinician in newborns who initially appear mildly affected but later on progress to have more severe disease. TH has been used in many multicentered clinical studies showing neuroprotective effects. However, it has several effects that the clinician needs to be aware during treatment including; cardiopulmonary, renal, hematological, and metabolic effects. Drug metabolism may be delayed, there may be clotting disorders and the tendency for infection and skin problems as well. Optimal patient care including adequate sedation, antibiotic treatment, fluid, and nutritional management are very important during the course of TH. Patients need to be fully monitored including vital signs particularly core temperature. Frequent blood work may be necessary to follow the general condition of the patient and side effects. Echocardiographic assessment, head ultrasound, amplitude integrated electroencephalography are other methods used to evaluate treatment effects and guide management. Rewarming after 72 h of TH is also a very important part of treatment. Rewarming should be completed within 4 12 h and close follow up including vital signs, respiratory, and circulatory conditions is required to detect the changes occurring in the patient and treat accordingly.