A simplified method for head cooling: Feasibility and safety

Abstract

Objective: To study feasibility of a simplified method of head cooling using ice water filled rubber gloves in full term infants with moderate to severe hypoxic-ischemic encephalopathy and whether very early induced hypothermia would decrease mortality and incidence of convulsions in this group of infants.

Study Design: In this single center prospective cohort study, full term inborn infants were assigned to intervention cohort or control cohort based on the 24 hours on call staff physician preference. Patient selection was based on perinatal evidence of hypoxic-ischemic insult and clinical neurological findings on admission suggestive of moderate to severe hypoxic-ischemic encephalopathy. Hypothermia was passively initiated at delivery and was actively induced on admission. A simplified approach to induced head cooling was used by applying ice water filled rubber gloves. Combined selective head cooling and mild systemic hypothermia approach was applied. Cooling was continued for 72 hours. Short term outcomes of infants in the two cohorts were compared.

Results: 106 infants were enrolled, 54 infants in intervention cohort and 52 infants in control cohort. Active cooling was initiated in the intervention cohort at a median postnatal age of 57 minutes. The method of cooling was easy to learn and adopt by our unit members. The mortality rate was not significantly different between the two cohorts; 8/54 intervention cohort vs. 11/52 in the control cohort, p value 0.45. Infants in the intervention cohort had statistically significant reduction in the incidence of clinical convulsions, 14/54 vs. 25/52, p value 0.026. Fewer infants in the intervention group had abnormal electroencephalogram; 12/46 (26%) vs. 18/43 (42%) in the control group, however this did not reach statistical significance.

Conclusion: This simplified method of head cooling is feasible and might be helpful to treat newborn infants with hypoxic-ischemic encephalopathy in centers where sophisticated equipments are not available.