Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude
CPT4 code
Name of the Procedure:
Initiation of Selective Head or Total Body Hypothermia in the Critically Ill Neonate
Summary
Initiation of hypothermia treatment for critically ill newborns involves cooling the baby's body or head to reduce brain injury following conditions such as lack of oxygen during birth. This is done under close monitoring to ensure the baby’s temperature is appropriately controlled.
Purpose
The procedure aims to reduce brain damage caused by oxygen deprivation during birth, promoting better long-term neurological outcomes.
Indications
- Neonatal encephalopathy (brain dysfunction)
- Birth asphyxia (oxygen deprivation)
- Abnormal clinical, imaging, and laboratory data indicating risk of brain injury
Preparation
- Review clinical, imaging, and laboratory data to confirm eligibility.
- Place an esophageal temperature probe to accurately monitor body temperature.
- Conduct an amplitude-integrated electroencephalography (aEEG) to evaluate brain activity.
- Ensure the neonate is stable and any complications are managed.
Procedure Description
- Selection: Review clinical, imaging, and laboratory data to select appropriate patients.
- Temperature Monitoring: Confirm the accurate placement of an esophageal temperature probe.
- Brain Activity Monitoring: Evaluate using amplitude-integrated electroencephalography.
- Cooling: Initiate cooling using specialized equipment:
- For selective head cooling, a cooling cap is placed on the neonate's head.
- For total body cooling, the entire neonate is placed on a cooling blanket or mattress.
- Maintenance: Continuously monitor temperature and adjust cooling devices accordingly.
- Duration: The cooling typically continues for 72 hours.
- Rewarming: Slowly rewarm the neonate over several hours to avoid complications.
Duration
The cooling phase lasts approximately 72 hours, followed by a gradual rewarming period.
Setting
This procedure is performed in a Neonatal Intensive Care Unit (NICU).
Personnel
- Neonatologists
- NICU Nurses
- Respiratory Therapists
- Neurologists
- Radiologists
Risks and Complications
- Skin injuries from cooling equipment
- Bleeding or clotting complications
- Electrolyte imbalances
- Infections
- Arrhythmias (irregular heartbeats)
Benefits
- Reduced risk of severe brain injury
- Improved long-term neurological outcomes
- Lower mortality rates
Recovery
- Continuous monitoring until the baby is stable post-procedure
- Gradual rewarming to normal body temperature over several hours
- Regular follow-up appointments to assess developmental progress and any late complications
Alternatives
- Supportive care without cooling, although this may have worse outcomes.
- Experimental treatments like neuroprotective drugs, which are not yet widely validated.
Patient Experience
- The neonate will typically be sedated or receive pain relief to minimize discomfort.
- Pain management and supportive care to ensure comfort during and after the procedure.
This template captures all the essential aspects of the procedure, providing a comprehensive overview in a concise format.