Experimental evidence shows that lack of sedation

during HT may abolish the neuroprotective effect (17).

10. Monitor urine output. Catheterization may be necessary to maintain accurate fluid balance in sedated

cooled infants.

11. Monitor core, surface, and scalp temperature (if on

head cooling) every 15 minutes during induction and

maintenance phases of HT, and during rewarming in

manual modes. In servo modes, core, surface, and scalp

temperatures can be monitored every 30 minutes during maintenance phase of HT.

12. Monitor skin for changes, and change the position of

the infant every 8 hours to avoid pressure sores.

G. Selective Head Cooling (SHC)

SHC with mild systemic hypothermia (rectal temperature

34°C to 35°C) was the first method in clinical use and aims

to selectively reduce the temperature of the brain more

than the rest of the body, thus minimizing the systemic

adverse effects of HT (18). It is currently not feasible to

accurately measure temperature in different parts of the

brain, and the large size of the infant’s head can preclude

achieving significant cooling in the deep brain without

reducing core temperature (19). There is no evidence to

suggest that either of the cooling methods (SHC or WBC)

is superior to the other. SHC with mild HT has been

reported to significantly reduce death and disability after

perinatal asphyxia (1,20).

Equipment

1. Olympic Cool-Cap system (Figs. 45.3 and 45.4) (Natus

Medical Incorporated, San Carlos, California)

a. Olympic Cool-Cap system (control unit and cooling

unit) (Fig. 45.3)

b. Radiant warmer with skin/servo temperature sensor

(Fig. 45.4)

c. Bag of sterile water, 1 L (Fig. 45.3)

d. Cool-Cap: Soft cap with water circulating channels

(Fig. 45.5A, B)

e. Water cap retainer: Ensures maximum surface area

contact between the water cap and the infant’s scalp

(Fig. 45.5C)

f. Outer insulator cap: Reflects external heat from the

radiant warmer (Fig. 45.6A)

g. Heat shield: Reflective shield to place over head and

neck to block heat from the radiant warmer (Fig.

45.6B)

h. Connecting tubes: Main hose pumps water in

and out of the cooling unit (Fig. 45.3); cap connector tubes connect the cap to the main hose and

feed water in and out of the water cap (Fig. 45.5A,

B).