Neonatal Encephalopathy Cooling Guidelines

The Neonatal Encephalopathy Cooling Guidelines (NECG) Tool identifies patients at risk for neonatal encephalopathy and incorporates the numerous criteria that must be met in order for a patient to meet current guidelines for therapeutic hypothermia treatment.
  • Neonatal encephalopathy is defined as a condition in neonates when two of the following signs are present: altered consciousness, altered muscle tone, or abnormal primitive reflexes.
  • Therapeutic hypothermia is an active treatment that aims to achieve and maintain a specific body temperature for a duration of time in an effort to improve health outcomes in infants with perinatal brain injury. In order for therapeutic hypothermia to be recommended, the patient must meet clinical and biochemical criteria.
  • Sarnat staging is used to categorize encephalopathic infants as normal, mild, moderate, or severe. To meet the current criteria for therapeutic hypothermia, infants must be moderately or severely encephalopathic.
  • Neonates who are encephalopathic are eligible for therapeutic hypothermia, however, encephalopathy can have many causes. Therefore, clinical judgement should be used to determine if a patient should receive therapeutic hypothermia treatment on a case by case basis.
Therapeutic hypothermia is one of the only treatments available to decrease neurological morbidity in patients with perinatal brain injury. The Neonatal Neurocritical Care Group at the Children’s Hospital of Wisconsin has identified that physicians often incompletely document clinical and biochemical criteria needed to support decisions to initiate therapeutic hypothermia. The purpose of this tool is to assist healthcare providers with decision making and documentation in cases where therapeutic hypothermia treatment is a consideration.
  • Prempunpong, C., Chalak, L. F., Garfinkle, J., Shah, B., Kalra, V., Rollins, N., and Boyle, R. (2018). Prospective research on infants with mild encephalopathy: The PRIME study.38(1), 80-85. 10.1038/jp.2017.164
  • Robertson, C., and Finer, N. (1985). Term infants with hypoxic-ischemic encephalopathy: Outcome at 3.5 years. Developmental Medicine and Child Neurology, 27(4), 473-484.
  • Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol 1976; 33(10): 696–705.
  • Shalak, L. F., Laptook, A. R., Velaphi, S. C., and Perlman, J. M. (2003). Amplitude-integrated electroencephalography coupled with an early neurologic examination enhances prediction of term infants at risk for persistent encephalopathy. Pediatrics, 111(2), 351-357.
  • Kelly Staricha - Product Design and Strategy
  • Yash Vesikar - Solution Engineer
  • Susan Cohen, MD - Subject Matter Expert
  • Erwin Cabacungan, MD - Subject Matter Expert
  • Katherine Carlton, MD - Subject Matter Expert
  • Jodi Garvin, MD - Subject Matter Expert

Qualifying Questions

Is the neonate's condition suggestive of encephalopathy?

Neurological Questions: Seizures

Does the neonate present with seizures?

Neurological Exam: Sarnat

Qualifying Questions

Is the infant's gestational age 36 weeks or more?

Is the infant 6 hours old or less?

Is the infant's birth weight 1800g or more?

Absence of congenital abnormalities?

Absence of chromosomal anomalies?

Absence of alternate cause for encephalopathy?

Blood Gas Questions

Is there an available Cord or Postnatal Blood Gas pH obtained within 1hr of birth?

Enter Base Deficit:

- mEq/L

Enter Cord or Postnatal Blood Gas pH obtained within 1hr of age:

History Questions

History of an acute event?

Enter 10 minute Apgar score:

Assisted ventilation from birth continued for at least 10 min?


Based on the current literature, this patient meet criteria for therapeutic hypothermia treatment Please use your clinical judgement to decide the best course of treatment for your patient.