RESUMO
Hypothermia has been shown to be neuroprotective in some newborns with moderate-to-severe perinatal hypoxic-ischemic encephalopathy (HIE). In 2006, the American Academy of Pediatrics recommended that institutions that choose to use therapeutic hypothermia do so in the context of a rigorous protocol, with systematic collection of patient data including neurodevelopmental follow-up. In this report, we describe our experience with implementation of a 'Hypothermia for HIE' program in a single tertiary care Neonatal Intensive Care Unit (NICU). Important components of the program include detailed protocols, staff and outreach education, early initiation of cooling in both inborn and outborn patients, maintaining stable hypothermia during neonatal transport, and comprehensive neurologic evaluation including serial EEGs, brain MRI and neurodevelopmental follow-up. In the first 2 years of the program, we have used hypothermia therapy in 21 patients, 18 with perinatal and 3 with early postnatal events leading to HIE. Eleven of fifteen outborn patients were cooled prior to and during transport, resulting in initiation of therapy 3 h sooner than if therapy had been delayed until arrival at our center. While lowering the body temperature of encephalopathic newborns is not difficult, addressing the complex medical problems of this vulnerable group of patients requires an experienced multidisciplinary team in regional referral centers.
Assuntos
Hipotermia Induzida/métodos , Hipóxia-Isquemia Encefálica/terapia , Terapia Intensiva Neonatal/métodos , Lesão Encefálica Crônica/etiologia , Eletroencefalografia , Seguimentos , Hospitais Universitários , Humanos , Hipotermia Induzida/efeitos adversos , Hipóxia-Isquemia Encefálica/complicações , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Transtornos das Habilidades Motoras/etiologiaRESUMO
Although there are several forces driving changes with regard to parents within neonatal intensive care units (NICUs), they all culminate in the ideals represented in family-centered care. This article examined the variables that are perceived by parents to be barriers to their assumption of parental roles while their infants were hospitalized in the NICU. Data were used to support and implement pragmatic changes in program development and service delivery within the NICU.