Neonatal Hypothermia: A Method to Provide Neuroprotection After Hypoxic Ischemic Encephalopathy

The evolving progression of hypoxic ischemic encephalopathy has devastating effects accounting for approximately 23% of the four million annual neonatal deaths globally. Of infants who survive, 25% to 55% will suffer significant neurologic sequelae (Pediatrics 2008;121:648-649; author reply 649-650). Scientific evidence has demonstrated significant improvements in clinical and developmental outcomes through therapeutic hypothermia. Interventions initiated within a predefined “therapeutic window” showed decreased secondary cellular injury and aptotosis. The aim of this article is to provide an account of the hypoxic event at the cellular level describing the progression of injury that leads to ongoing neuronal cell damage and death. Historical accounts of experimental and clinical trials to date are provided, which describe scientific evidence used to develop standardized treatment protocols for hypothermia after hypoxic ischemic encephalopathy. Details of current protocols are also provided. Lastly, a focus on nursing interventions with symptom management is provided, giving supportive rationale to assist the bedside nurse when caring for these complex patients in an effort to potentially improve short- and long-term outcomes.