323

45 Brain and Whole Body Cooling

46 Removal of Extra Digits and Skin Tags

47 Circumcision

48 Drainage of Superficial Abscesses

49 Phototherapy

50 Intraosseous Infusions

51 Tapping a Ventricular Reservoir

52 Treatment of Retinopathy of Prematurity

53 Peritoneal Dialysis

54 Neonatal Hearing Screening

55 Management of Natal and Neonatal Teeth

56 Relocation of a Dislocated Nasal Septum

57 Lingual Frenotomy

Miscellaneous

Procedures

IX

324

Ela Chakkarapani

Marianne Thoresen

45 Brain and Whole Body Cooling

Moderate therapeutic hypothermia (HT; rectal or esophageal temperature 33.5°C) initiated within 6 hours and continued for 72 hours reduces death or disability (NNT 6,

95% CI 5 to 9) and increases the number of survivors with

normal neurology after perinatal asphyxia (NNT 8, 95%

CI 5 to 17) (1–6). HT is delivered in newborn infants

as whole body cooling (WBC) using different types of

mattresses or wraps around the body, or as selective head

cooling (SHC) using a “coolcap” around the head (1–3).

A. Indications

To decrease death or disability in the following group of

infants (1–3)

a. ≥36 weeks’ gestation newborn infants <6 hours of age

b. Evidence of asphyxia (at least one of the four criteria

below must be met)

(1)Apgar score at 10 minutes of age ≤5

(2)Worst arterial or capillary or venous pH within 60

minutes of life <7

(3)Arterial or capillary or venous base deficit within 60

minutes of life ≥12 or 16

(4)Ventilated or resuscitated for at least the first

10 minutes after birth

and c or d

c. Moderate or severe encephalopathy characterized by

(1)Abnormal consciousness—lethargy or stupor or

coma and

(2)Hypotonia or abnormal reflexes (including oculomotor or pupillary abnormalities), or decreased/absent

spontaneous activity, or abnormal (distal flexion/

complete extension/decerebrate) posture, or absent/

weak suck, or incomplete/absent moro or

d. Clinical seizures

and

e. 30 minutes abnormal background activity or seizures in