Document Detail


Induced hypothermia for infants with hypoxic- ischemic encephalopathy using a servo-controlled fan: an exploratory pilot study.
MedLine Citation:
PMID:  19433516     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Several trials suggest that hypothermia is beneficial in selected infants with hypoxic-ischemic encephalopathy. However, the cooling methods used required repeated interventions and were either expensive or reported significant temperature variation. The objective of this pilot study was to describe the use, efficacy, and physiologic impact of an inexpensive servo-controlled cooling fan blowing room-temperature air. PATIENTS AND METHODS: A servo-controlled fan was manufactured and used to cool 10 infants with hypoxic-ischemic encephalopathy to a rectal temperature of 33 degrees C to 34 degrees C. The infants were sedated with phenobarbital, but clonidine was administered to some infants if shivering or discomfort occurred. A servo-controlled radiant warmer was used simultaneously with the fan to prevent overcooling. The settings used on the fan and radiant warmer differed slightly between some infants as the technique evolved. RESULTS: A rectal temperature of 34 degrees C was achieved in a median time of 58 minutes. Overcooling did not occur, and the mean temperature during cooling was 33.6 degrees C +/- 0.2 degrees C. Inspired oxygen requirements increased in 6 infants, and 5 infants required inotropic support during cooling, but this was progressively reduced after 1 to 2 days. Dehydration did not occur. Five infants shivered when faster fan speeds were used, but 4 of the 5 infants had hypomagnesemia. Shivering was controlled with clonidine in 4 infants, but 1 infant required morphine. CONCLUSIONS: Servo-controlled fan cooling with room-temperature air, combined with servo-controlled radiant warming, was an effective, simple, and safe method of inducing and maintaining rectal temperatures of 33 degrees C to 34 degrees C in sedated infants with hypoxic-ischemic encephalopathy. After induction of hypothermia, a low fan speed facilitated accurate temperature control, and warmer-controlled rewarming at 0.2 degrees C increments every 30 minutes resulted in more appropriate rewarming than when 0.5 degrees C increments every hour were used.
Authors:
Alan Horn; Clare Thompson; David Woods; Alida Nel; Adrie Bekker; Natasha Rhoda; Clarissa Pieper
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-11
Journal Detail:
Title:  Pediatrics     Volume:  123     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-01     Completed Date:  2009-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1090-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Neonatal Medicine, School of Child and Adolescent Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. alan.horn@uct.ac.za
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MeSH Terms
Descriptor/Qualifier:
Analgesics / administration & dosage
Analgesics, Opioid / adverse effects
Anticonvulsants / administration & dosage
Asphyxia Neonatorum / therapy*
Blood Pressure
Body Temperature
Clonidine / administration & dosage
Combined Modality Therapy
Cost-Benefit Analysis
Developing Countries*
Electroencephalography
Female
Follow-Up Studies
Heart Rate
Humans
Hypothermia, Induced / economics,  instrumentation*
Hypoxia-Ischemia, Brain / therapy*
Infant
Infant, Newborn
Male
Morphine / administration & dosage
Neurologic Examination
Pilot Projects
Rewarming / methods
Shivering / drug effects,  physiology
South Africa
Treatment Outcome
Chemical
Reg. No./Substance:
0/Analgesics; 0/Analgesics, Opioid; 0/Anticonvulsants; 4205-90-7/Clonidine; 57-27-2/Morphine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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