A NICU OT Student’s perspectives on the Online Brain Cooling Course – written by Maggie Crabtree
Although as a NICU OT student I have seen infants undergoing therapeutic hypothermia, I still wanted to learn more. Since I am participating in an internship with Synapse this summer I wanted to learn more about therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy (HIE) so as a first step, I completed Synapse’s online Brain Cooling Course.
In this multi-disciplinary, multi-site, webinar course, strong advocates and experts in the field of neonatology and neurology presented on various aspects of therapeutic hypothermia in infants with HIE.
There were a few major themes that ran throughout this course:
- The critical importance of early detection of infants with encephalopathy;
- Serial neurobehavioral testing using bedside exams, neuro-monitoring, and neuroimaging;
- Quality and Consistency of Care;
- Parental involvement in care and the importance of holding during and after cooling;
- Clear, concise communication from the medical team to the parents and family.
It is well known that an infant’s brain undergoes vast and rapid change in the first hours and days of life, and it is crucial that appropriate care and interventions are provided during this window of opportunity.
This course emphasizes the importance of NICU’s utilizing the most up to date technology and imaging systems, however, these are not always readily available in all units. Therefore, clinicians should advocate to add these devices to their hospital services and reach out to experienced imaging and brain monitoring (or aEEG; cEEG) mentors who may be able to provide assistance remotely for locations with limited resources.
QUALITY AND CONSISTENCY OF CARE
Once infants eligible for cooling are properly identified, it is important to ensure the entire medical team is proficient in the site’s specific protocol, in order to be available to provide cooling in a timely and consistent manner. The Brain Cooling Course places a huge emphasis on the quality of care metrics that should be measured by all cooling centers to ensure that protocols are followed and variances in practice are minimized; I enjoyed learning from several different faculty on the quality of care elements for infants undergoing cooling.
PARENT ROLES DURING COOLING
Parent and caregiver involvement in their child’s care from the very beginning of the NICU admission can help to decrease stress and increase bonding, and overall help to combat potential feelings of role alteration. In the Brain Cooling Course, there were several lectures on the benefit of parental involvement in their child’s care and specific instruction on activities that are safe and developmentally appropriate for parents to do with their child while they are being cooled and during the rest of their stay in the NICU. This is especially true when holding is not an option due to respiratory distress.
HOLDING DURING COOLING
Does your NICU offer parental holding for infants undergoing cooling?
When holding is an option, advocating for this to be done as soon as the infant is stable enough and potentially during the rewarming phase. If this is not offered in your NICU be sure to offer skin-to-skin as soon as possible after re-warming. Dr. Alexa Craig is a Neurologist in Maine, and in her presentation in the Brain Cooling Course, she shared lessons learned from her recent research which included interviews with parents and grandparents of infants undergoing cooling. She has also published several recent articles on this topic that are definitely worth checking out. CLICK HERE TO SEE A LIST OF ARTICLES BY DR. CRAIG ON PUBMED.
THE ROLE OF THE NICU THERAPIST
In addition to holding, providing parents with information about how they can provide positive sensory and feeding experiences to their newborn could assist in empowering parents to participate safely in their infant’s developmental and medical progress during and after cooling.
NICU Therapist can play a huge role with parent education and empowerment during their time in NICU, but furthermore, they can aid parents in their transition home through connections to community resources, follow-up clinics, or well-baby training.
Strong communication between the neuro-radiologist and the therapy team is crucial for targeting interventions based on neurodevelopmental and neurobehavioral representations of the child.
We know that there is a link between severity and location of injury to outcome in early childhood, therefore it is important to communicate this information to the family or caregiver, and provide a spectrum of outcome possibilities. This should also be communicated with the early intervention therapists, and these services should be initiated as soon as possible after NICU discharge to capitalize on the neuroplasticity the child is experiencing and ensure a safe transition home. Overall, clear, concise, and honest communication and care are essential for ensuring the most optimal outcomes for these infants and their families.
I truly enjoyed taking the time to dive deep into this topic through the Brain Cooling Course and would highly recommend other NICU professionals, even NICU therapists to do the same.
Click below to enroll in our Neonatal Brain Cooling Course!