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.
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