Chapter 45 ■ Brain and Whole Body Cooling 331

likely in an infant at birth, passive cooling should be initiated as soon as ventilation is established (23). This method

of cooling can be effective for days, depending on the environmental temperature, but it is usually used only until

active cooling equipment is available (24).

Technique

1. No radiant warmer or other methods of warming should

be initiated.

2. Keep the infant uncovered (small diaper may remain in

place).

3. Monitor core temperature with rectal or esophageal

probe. If overcooling occurs, infant can be rewarmed

slowly with a heat source (e.g., warm water bottles, overhead heating [with heat shield to the head]) (Fig. 45.21).

4. Maintain ambient temperature below 26°C.

5. On completion of a 72-hour course of cooling, achieve

rewarming at a rate of 0.5°C/h (i.e., from 33.5°C to

36.5°C in 6 hours).

Pitfalls

1. Core temperature monitoring is required to avoid

excessive cooling (24,25).

2. Variability of core temperature during passive HT is

high (23,24).

Cooling with Adjuncts

1. Gloves/Bottles Filled with Tap Water (Fig. 45.9)

Technique

a. Expose the infant fully and place in an open crib.

b. Remove all heat sources.

c. Maintain ambient temperature between 25°C and

26°C.

d. Use three rubber water bottles, filled with cold tap

water, to form a mattress and/or

e. Place rubber gloves filled with water at approxima-tely 10°C next to the groins, axillae, and neck

(26).