CRITERIA OF BRAIN –COOLING

Brain cooling to arrest brain damage is rapidly gaining acceptance in neonatal medicine. Newborn babies who have suffered a hypoxic insult peri-natally could be given the benefit of brain cooling. Time is of essence as it has to be started within 6 hours of birth.
Following are the criteria to brain cool.

Clinical evidence of moderate to severe HIE is defined by criteria A, B and C below:

A. Infant equal or > 36 weeks GA and at least one of the following:
* Apgar score equal or less than 5 at 10 min after birth
* Continued use for resuscitation, including endotracheal or mask ventilation at 10 min after birth.
* Acidosis defined as either umbilical cord pH or any arterial pH within 60 min after birth < 7.00
* Base deficit equal or greater than 16 mMol/L in umbilical cord blood sample or any blood sample within 60 minutes after birth.
B. Infants with moderate to sever encephalopathy consisting of altered state of consciousness ( as shown by lethargy, stupor, or coma) and at least one of the following:
* hypotonia
* Abnormal reflexes , including oculo-motor or papillary abnormalities
*Absent or weak suck.
* Clinical seizures

If the infant is paralyzed, assume an abnormal evaluation for criteria B and proceed to criteria C

C. Infant has an amplitude-integrated EEG/ cerebral function monitor ( aEEG/ CFM) recording of atleast 20 minutes duration that shows either moderately/severely abnormal aEEG background activity (score of 2 or 3) or seizures.

Source: Olympic Cool-Cap system