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Category Archives: Hypoxic-Ischemic Encephalopathy

Therapeutic Cooling in Area of Limited Resources

neonatal-cooling

(pic: http://www.ucl.ac.uk/impact/case-study-repository/neonatal-cooling)

Sometimes, you get amazed at how new technologies are developed to address the prime needs of newborn infants in their compromised states. One such technology developed was hypothermic treatment of infants who were born hypoxic or asphyxiated. It is unfortunate however that such technology is not available in all birth institutions, hence the need to innovate in order to cope up and be at par as far as clinical outcomes are concerned.

A year ago, I attended a workshop on how to provide a whole body hypothermia for babies who are hypoxic-ischemic upon birth. It was so simplified that all you need is just a radiant warmer with a rectal probe, and ice packs. An algorithm was provided on how to bring the baby into therapeutic hypothermia and how to monitor his temperature.

Unfortunately, in my place of practice, the specified ice packs as well as rectal probe (which should be included in the radiant warmer purchased by the hospital) are not available.

One night, I was called to co-manage a baby who was born via emergency Cesarean section to a mother who had eclampsia. The baby came out without heart tones and resuscitation was performed accordingly. However, just few minutes after heart beat was restored, baby had seizures at the operating room. He then qualified to be treated with whole body hypothermia, based on the criteria provided.

radiant warmer

(Ohmeda Infant Radiant Warmer System)

The baby was immediately transferred to the NICU for intensive care. He was placed on the radiant warmer, naked, except for diaper. Temperature was then brought down and tried to be maintained within the recommended range. One ice pack was placed on the back, and another one was placed on his chest. The ice packs were placed or removed accordingly depending on the temperature of the baby.

ice packs.jpg

As we do not have a rectal probe that should be put inside the rectum until the intervention is over, we had to keep monitoring the rectal temperature every 5-15 minutes. After loading dose of anti-convulsant, the seizures did not recur anymore.

After 72 hours, the temperature was slowly increased until normal body temperature. Unfortunately, the mother died after the procedure that the baby was unable to have skin-to-skin-contact with the mother at all.

Baby was discharged after a week from the hospital.

Are you as excited to know progress of the baby’s development?

At 4 months after birth, the baby was referred to a Developmental Pediatrician. As per the doctor’s evaluation, the baby’s developmental milestones are at par with chronologic age. The infant, despite the absence of  bonding with the mother, was also able to show normal affect, thanks to relatives who took turn in taking care of the baby.

This is a testament that babies can be saved, the potentials may still be brought to optimum, with diligence and resourcefulness.

(This blog is dedicated to the Pediatric Residents and NICU Nurses of SLU-HSH who took turn in taking care of this infant.)

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