Moderate Hypothermia: Is Selective Head Cooling or Whole Body Cooling Better?
Kimberly A. Allen PhD, RN
Shelia Gephart

Advances in Neonatal Care
April 2014 
Volume 14  Number 2
Pages 113 - 118
  PDF Version Available!

Hypoxic-ischemic encephalopathy (HIE) is one of the most serious birth complications affecting full-term infants1 occurring in 1.5 to 2.5 per 1000 live births.2,3 Hypoxic-ischemic encephalopathy results in a brain injury from a hypoxic-ischemic event during the prenatal, intrapartum, or postnatal period preventing adequate blood flow to the infant's brain.4 Infants with HIE experience associated morbidities and a significant mortality rate with 40% to 83% not surviving past 2 years of age or having severe disabilities.5-7 The long-term neurological consequences of HIE include mental retardation, epilepsy, and cerebral palsy.7The incidence of HIE has not declined with advances in obstetric care (ie, fetal monitoring) aimed at preventing hypoxic-ischemic events8; thus, much of the current neonatal research focuses on preventing further brain injury after the hypoxic-ischemic event.9 In the past, treatment options were limited to standard medical treatment (eg, antiepileptic medications or respiratory support) and maintaining normothermia.10,11 Currently, moderate hypothermia5,12-14 is utilized as a main treatment for infants with HIE, but the long-term success of the treatment on infant outcomes remains inconclusive.The challenge with drawing conclusions about the effect of moderate hypothermia on infant outcomes relates, in part, to the multiple ways the treatment is administered. Large clinical trials have delivered the intervention using primarily 2 methods of delivery: selective head cooling (see Figure 1) or whole body cooling (see Figure 2). The complexity in this treatment modality includes the use of different target core temperatures and variable lengths of time for treatment. Tagin et al15 conducted a systematic review identifying randomized controlled trials (n = 7) comparing moderate hypothermia with normothermia (standard care) in neonates with HIE. Of the 7 studies, 4 of the studies employed whole body cooling5,7,14,16 as the intervention and 3 of the studies

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