Identification of infants at risk of hypoxic ischaemic encephalopathy (HIE) and initiation of therapeutic hypothermia in a non-cooling level 2 neonatal unit

Introduction Therapeutic hypothermia improves outcome of infants with Hypoxic-ischaemic encephalopathy (HIE) when initiated early. This observational study aims to determine capability of a non-cooling level 2 unit to identify at risk infants and initiate cooling. Methods We retrospectively examined case notes of infants meeting the TOBY trial ‘A’ criteria over a 12 month period. Results 44 infants met TOBY criteria. Cerebral function monitoring (CFM) was used in 31, and abnormal in 12. Of these, 11 were transferred for cooling and 1 had care withdrawn. For 11 cooled infants CFM was commenced within 100 min and decisions regarding cooling made within 4 h. All were passively cooled from birth with rectal temperature monitoring in 7/11. 8/11 had central venous/arterial access. Active cooling was commenced prior to transfer in 7/11. All reached target temperature of 33.5 within 6 h. 2 of 11 cooled infants were less than 36 weeks gestation and 1 was dysmorphic. Discussion This study underlines the importance of early local identification and treatment of eligible infants and the development of good links with cooling centres. Choice of cooling method and use of CFM was inconsistent, needing improvement through guidelines and training. We used entry criteria for the TOBY trial to identify infants. Interestingly 3 cooled infants were outside these criteria perhaps reflecting ‘cooling creep’ as neonatologists become more comfortable with cooling. Conclusion Therapeutic hypothermia requires specialist input. However, we show that a non-cooling level 2 neonatal unit can reliably identify infants at risk and safely initiate cooling early, prior to transfer.