TRIPASS XR تري باس

 

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