Neuroprotection Care Pathway for Infants with Hypoxic-Ischaemic Encephalopathy

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Abstract

This pathway has been designed to inform the diagnosis, referral, transport and management of infants with moderate and severe hypoxic-ischaemic encephalopathy who are born and/or treated in Scotland.

This pathway has been devised to ensure safe, timely and high quality care is available to all infants who may be eligible for therapeutic hypothermia (TH). Guidelines have been developed largely in accordance with the BAPM Framework for Practice for Therapeutic Hypothermia.

The pathway gives guidance in the following areas:

  1. Diagnosis and management of HIE
  2. Referral and transport of infants with HIE
  3. Ongoing management of infants with HIE undergoing therapeutic hypothermia

Contents:

1. Neuroprotection Care Pathway for Infants with Hypoxic-Ischaemic Encephalopathy.................... 4
2. Location of care......................................................................................................................................... 4
3. Principles of assessment........................................................................................................................... 4
4. Principles of care during and after Therapeutic Hypothermia............................................................. 5
5. Parents ...................................................................................................................................................... 6

Flowcharts and Documentation
Therapeutic Cooling Decision Aid ................................................................................................................. 7
Neurological Examination (based on Modified Sarnat scoring system).................................................... 8
CFM Criteria for Cooling................................................................................................................................ 8
Pre-Cooling Documentation Aid (0-6h).......................................................................................................... 9
Therapeutic Cooling Management Aid - Referring Centres......................................................................... 10
Therapeutic Cooling Management Aid - Cooling Centres ........................................................................... 11
Therapeutic Cooling Management Aid - Transport Teams.......................................................................... 13

Appendices
Appendix 1. Audit standards........................................................................................................................ 13
Appendix 2. Cooling in Special Circumstances ........................................................................................... 14
Appendix 3. Ongoing management of the cooled infant with HIE............................................................ 16
Appendix 4. Parent Information Leaflet. Hypoxic Ischaemic Encephalopathy in the Newborn............ 22
Appendix 5. Support for families.................................................................................................................. 24
Appendix 6. Effect of hypothermia on medications................................................................................... 25
Appendix 7. Individuals and organisations involved in production and endorsement......................... 28

Editorial Information

Last reviewed: 01 December 2020

Next review: 31 December 2024

Author(s): Dr Julie-Clare Becher (Chair of the Scottish Cooling Group), Consultant Neonatologist, Royal Infirmary of Edinburgh, NHS Lothian; Dr Sean Ainsworth, Consultant Neonatologist, Victoria Hospital, Kirkcaldy, NHS Fife; Dr Shetty Bhushan, Consultant Neonatologist, Ninewells Hospital & Medical School, NHS Tayside; Dr Michael Colvin, Consultant Paediatrician, Forth Valley Hospital, NHS Forth Valley; Dr Bethan Dean, Grid Trainee, NHS Yorkshire and Humber; Dr Allan Jackson, Consultant Neonatologist, Princess Royal Maternity, NHS Greater Glasgow and Clyde, and Neonatal Transport Lead for ScotSTAR; Dr Lesley Jackson, Consultant Neonatologist, Royal Hospital for Children, NHS Greater Glasgow and Clyde; Dr Lambrini Psiouri, Consultant Neonatologist, Aberdeen Maternity Hospital, NHS Grampian; Dr Natalie Smee, Grid Trainee, NHS Greater Glasgow and Clyde

Version: 2

Co-Author(s): Other stakeholders: Other Members of the Scottish Cooling Group; Dr Ruth Allen on behalf of Scottish Paediatric Radiologists; Ms Hilary Cruickshank on behalf of Scottish Physiotherapists; Ms Catherine MacDonald, Lead Midwife, NHS Western Isles; Dr Tushar Banerjee, Consultant Paediatrician, NHS Western Isles; Dr Jamie Houston, Consultant Paediatrician, Oban, NHS Highland

Approved By: The Scottish Cooling Group