330 Section IX ■ Miscellaneous Procedures

Precautions

1. Use only sterile water.

2. Monitor for scalp changes every 12 hours.

3. SHC may not be appropriate for babies weighing

<1.8 kg, due to reduced effectiveness of cooling in

small for gestational age infants (21).

4. Avoid having the straps on the blue Lycra cap too tight

to avoid swelling of the neck (Fig. 45.7).

Disadvantages

1. Involves repeated adjustments of the radiant warmer

output and Cool-Cap water temperature.

2. It is not possible to store temperature data.

3. Rewarming rate cannot be individualized to infant.

H. Whole Body Cooling (WBC)

WBC can be achieved by

1. Passive cooling.

2. Cooling with simple adjuncts such as water bottles, gloves

filled with water, gels, or fan.

These methods are effective, but they are more

difficult to use and are labor intensive. It is difficult to

achieve stable temperature over a long period.

3. Manually controlled cooling machine and mattress

4. Servocontrolled cooling machines with body wrap or

mattress.*

Temperature, blood pressure, and heart rate variation during cooling with manual and servocontrolled

WBC and manual SHC is shown in Figure 45.8.

Passive Cooling

After perinatal asphyxia, the metabolism of infants is naturally low, and the core temperature will fall unless active

warming is commenced (22). When perinatal asphyxia is

Neck swelling & impression caused

by tight water cap retainer strap

Fig. 45.7. Neck swelling and impression caused by placing the

strap of the water cap retainer too tightly.

A B

Fig. 45.6. A: Placement of insulating cap over the water cap retainer. The patches in the interior of the

insulating cap attach to the Velcro fasteners on the exterior of the water cap retainer. B: Heat shield placed

over the face and head of the infant.

*Each of these methods will be described with the corresponding figures.