HIE: A worldwide problem with few answers – but we have one!

Worldwide birth asphyxia, neonatal encephalopathy and hypoxic-ischemic encephalopathy (HIE) account for more than 25% of infant deaths and without treatment, neonatal encephalopathy is a condition that often results in adverse outcomes including death, cerebral palsy, developmental delay, and seizure disorder. 

In the US and other developed nations, therapeutic hypothermia has become the standard of care for infants born with neonatal encephalopathy after intrapartum distress and with evidence of academia, unfortunately, in many countries, there are no services to treat this devastating condition.  When therapeutic hypothermia is initiated within 6 hours of age, to a target core body temperature of 33.5 degrees Celsius and continued for 72 hours, it has been demonstrated to have the capability to prevent death and major disability during the neonatal period.  

Caring for infants with HIE undergoing hypothermia can be complicated and several known side effects occur with some regularity.

Caring for infants with HIE undergoing hypothermia can be complicated and several known side effects occur with some regularity. Click To Tweet

Due to the low frequency of infants presenting with HIE and the high risk for complications, most NICU’s who provide cooling for babies with HIE conduct staff training and equipment in-services at least on an annual basis.  Some States, including my home State of California, have passed guidelines on the minimum requirements for cooling centers.  These guidelines include the minimum education requirements of staff, quality improvement measurements, the type of assessment, monitoring, imaging, follow-up care and specialty consultations that must be provided in order to receive State funds for caring for these infants.   If you’d like to see California’s 2016 Guidelines, click here. 

Although establishing minimum standards will ensure safe and consistent care for infants with HIE, it also creates a burden on NICU educators and administration to comply.  Over the last few months, we have been hard at work to create the only online brain cooling course that will not only help you in your individual practice but is designed for entire NICU teams to standardize their knowledge and practice as well.   

This course is taught by an international panel of nursing and medical experts who share their wealth of knowledge and experience on this topic with you.  They will elevate your understanding of the pathophysiology of HIE and the benefits of cooling, and familiarize you with the current best practices related to caring for infants undergoing cooling, such as bedside assessment and seizure management, and an in-depth look at various high-risk scenarios that often arise during those 72 hours of cooling and beyond (such as fat necrosis and feeding issues).  Collectively, the course faculty has more than 200 years of cooling experience!!!

I’d like to take a few moments to share a few highlights from the Brain Cooling Course.  

1. Like any good story, I think it is important to start at the beginning and offer a thorough understanding of where we are and why.  So for all of us working in the NICU, it was essential to provide a few foundational lectures to set the stage for the rest of the Brain Cooling Course, and we chose to begin with an overview of the pathophysiology of HIE and the evidence that has demonstrated cooling is an effective treatment to reduce death and disability when initiated within the first 6 hours of life.  Since HIE is a two-phase disease, cooling aims to minimize or eliminate the brain’s secondary energy failure by decreasing reperfusion, blocking the release of several inflammatory cascade pathways, and reducing overall brain metabolism. Dr. Lina Chalak, a neonatologist and clinical research expert in the area of HIE and aEEG, provides a thorough review of the pathophysiology of HIE (from mild to severe).
2. The history of how therapeutic hypothermia has become the standard of care for HIE is fascinating and has taken more than 20 years to evolve to the place it is today, and by some reports even longer than that.  A brief history of the therapy and the animal and human trials is reviewed by several of our faculty presenters with a look at what the future holds as many clinical trials are in development and in progress.
3. Since cooling is not a completely benign intervention and potentially involves separating an infant from their parent, placing invasive lines, exposing them to antibiotics, delaying breastfeeding or enteral nutrition, it is important to be aware of those conditions that mimic HIE and to rule those out whenever possible before committing an infant and their family to hypothermia treatment.  A complete assessment can not only ensure that those infants who are eligible and may benefit are provided with therapeutic hypothermia, but will also prevent as much as possible cooling those infants where no benefit has yet been proven.  Dr. Courtney Wusthoff, a neonatal neurologist, from Stanford University provides a comprehensive lecture on the physical exam findings of an infant with neonatal encephalopathy.
4. As with any situation we encounter in the NICU, the first thing we need to do is assess. Assessment is key to determining who is eligible for cooling.  Rachelle Sey, MSN, CNS at Sharp Mary Birch in San Diego is one of our faculty presenters for the Brain Cooling Club and she shares the system their team created for bedside NICU nurses and community hospital nurses to assess infants who potentially meet the criteria for cooling during the first 5 hours of life if they don’t immediately qualify for transfer or cooling.  Since the therapeutic window for cooling is so short, it is essential that every member of your team is trained to identify eligible infants and know the importance of early referral.  As we often say “Time is Brain!”.  Nurses working in centers who don’t provide cooling are essential to the success of your NICU’s cooling program and Rachelle shares what has worked for their network of hospitals so that no baby is missed. 
5. After the foundations have been set, we launch into 10 more short lectures on topics such as neuroimaging the HIE infant, seizure identification and management, how to read EEG and aEEG, skin care issues, creating clinical pathways, feeding assessment post-cooling, parent communication, and quality improvement metrics.

As you can see the Brain Cooling Club provides you with all the information you need to refine your practice or initiate cooling in your NICU.  If you’d like to see all the topics that we cover in course, click here to download a course brochure.  And if you would like to download a free copy of our Cooling Program Guidelines and Staff Training Checklist, just click the image below.

.Want more education on HEI and cooling? I’ve got an amazing course with an international faculty that are passionate on the topic of cooling.