From the Guidelines
Therapeutic hypothermia should be offered to newly born infants born at or near-term with evolving moderate to severe hypoxic-ischemic encephalopathy, as per the Beveno VII criteria, and should be initiated and conducted under clearly defined protocols with treatment in neonatal intensive care facilities and with the capability for multidisciplinary care, as recommended by 1 and 1.
Key Considerations
- The treatment should be implemented according to the studied protocols, which currently include commencement within 6 hours following birth, continuation for 72 hours, and slow rewarming over at least 4 hours, as suggested by 1.
- Whole body cooling and selective head cooling are both appropriate strategies, as stated in 1 and 1.
- Carefully monitor for known adverse effects of cooling, such as thrombocytopenia and hypotension, as warned by 1 and 1.
- All treated infants should be followed up longitudinally, as recommended by 1 and 1.
Implementation
- Assess the patient's risk level based on their clinical presentation and initiate therapeutic hypothermia accordingly.
- Ensure that the treatment is conducted in a neonatal intensive care facility with multidisciplinary care capabilities.
- Monitor the patient closely for any adverse effects and adjust the treatment protocol as needed.
- Ensure longitudinal follow-up for all treated infants to assess the effectiveness of the treatment and potential long-term effects.
From the Research
Therapeutic Hypothermia Criteria
To answer the question regarding the Sarnat criteria (also known as the Sarnat and Sarnat staging or the Sarnat staging) which is very similar to what is being asked, "What to do per Sarnat 3 criteria" or "What to do per beveno 7 criteria" but no information is provided about "beveno 7 criteria" in the given studies. However, we can provide information on the Sarnat staging which is used to classify the severity of hypoxic-ischemic encephalopathy (HIE) in newborns:
- Stage 1: Mild HIE - symptoms are mild and may include hyperalertness, jitteriness, and a normal to mildly abnormal neurological examination.
- Stage 2: Moderate HIE - symptoms are more pronounced and may include lethargy, seizures, and a more abnormal neurological examination.
- Stage 3: Severe HIE - symptoms are severe and may include stupor, coma, and a severely abnormal neurological examination.
Treatment of HIE
The treatment of HIE typically involves therapeutic hypothermia, which has been shown to improve outcomes in newborns with moderate to severe HIE 2, 3, 4, 5, 6.
- Therapeutic hypothermia involves cooling the baby's body temperature to a lower than normal level, typically between 33.5°C and 34.5°C, for a period of 72 hours.
- The goal of therapeutic hypothermia is to reduce the extent of brain injury caused by the lack of oxygen and blood flow to the brain.
Key Considerations
When treating HIE with therapeutic hypothermia, it is essential to consider the following:
- Timing of initiation: Therapeutic hypothermia should be initiated as soon as possible after birth, ideally within the first 6 hours of life 3.
- Depth and duration of hypothermia: The depth and duration of hypothermia should be carefully monitored and adjusted as needed to ensure that the baby's body temperature remains within the target range 3.
- Rewarming rate: The rewarming rate should be carefully controlled to prevent rapid changes in body temperature, which can cause further brain injury 3.
Note: There is no information provided in the studies about "beveno 7 criteria". The information provided is based on the Sarnat staging which is used to classify the severity of hypoxic-ischemic encephalopathy (HIE) in newborns.