Neuroprotection Care Pathway for Infants with Hypoxic-Ischaemic Encephalopathy

This pathway has been designed to inform the diagnosis, referral, transport and management of infants with moderate and severe hypoxic-ischaemic encephalopathy who are born and/or treated in Scotland.

This pathway has been devised to ensure safe, timely and high quality care is available to all infants who may be eligible for therapeutic hypothermia (TH). Guidelines have been developed largely in accordance with the BAPM Framework for Practice for Therapeutic Hypothermia.

The pathway gives guidance in the following areas:

1. Diagnosis and management of HIE
2. Referral and transport of infants with HIE
3. Ongoing management of infants with HIE undergoing therapeutic hypothermia

Contents:

1. Neuroprotection Care Pathway for Infants with Hypoxic-Ischaemic Encephalopathy.................... 4
2. Location of care......................................................................................................................................... 4
3. Principles of assessment........................................................................................................................... 4
4. Principles of care during and after Therapeutic Hypothermia............................................................. 5
5. Parents ...................................................................................................................................................... 6

Flowcharts and Documentation
Therapeutic Cooling Decision Aid ................................................................................................................. 7
Neurological Examination (based on Modified Sarnat scoring system).................................................... 8
CFM Criteria for Cooling................................................................................................................................ 8
Pre-Cooling Documentation Aid (0-6h).......................................................................................................... 9
Therapeutic Cooling Management Aid - Referring Centres......................................................................... 10
Therapeutic Cooling Management Aid - Cooling Centres ........................................................................... 11
Therapeutic Cooling Management Aid - Transport Teams.......................................................................... 13

Appendices
Appendix 1. Audit standards........................................................................................................................ 13
Appendix 2. Cooling in Special Circumstances ........................................................................................... 14
Appendix 3. Ongoing management of the cooled infant with HIE............................................................ 16
Appendix 4. Parent Information Leaflet. Hypoxic Ischaemic Encephalopathy in the Newborn............ 22
Appendix 5. Support for families.................................................................................................................. 24
Appendix 6. Effect of hypothermia on medications................................................................................... 25
Appendix 7. Individuals and organisations involved in production and endorsement......................... 28