"The most trying ordeal a human being sustains is the ordeal of birth." - Jos. B. De Lee, MD
The birth of a child is an amazing experience, filled with months of excitement and preparation for the arrival of the baby. But families rarely expect to deliver a baby that requires the specialized care of the newborn intensive care unit (NICU). They are beset with shock and disbelief that their baby requires critical care.
Life-saving measures will be started by the referring facility and the child will be stabilized; however, transferring them is often the only option to continue life-saving therapy, particularly induced hypothermia, which is used to decrease brain metabolism and treat babies with hypoxic ischemic encephalopathy (HIE).
Bonita Makdad, MD, FAAP, Director of Commonwealth Neonatology and Medical Director of Bon Secours Virginia Health System's NICU, recognized the tremendous stressor for families when babies are admitted to the NICU and transferred to another facility. When an infant needed induced hypothermia as a treatment for birth asphyxia, hospitals offering this service were 1-2 hours away.
Makdad approached the nursing staff about the possibility of offering induced hypothermia to avert the transport of patients for this particular therapy, and by collaborating with physicians St. Mary's Hospital NICU added a hypothermia program July 1, 2008.
It is the first NICU with a hypothermia program in the Richmond, VA area and will offer time-sensitive care for infants throughout the region. The 21-bed NICU includes myriad state-of-the-art neonatology, including nitric oxide high-frequency ventilation and a transport team. David Goodwin, MD, MSHA, FAAP, a neonatologist with Commonwealth Neonatology, was the physician champion in the development of the Induced Hypothermia Protocol.
HIE affects full term and near-term infants who suffer from unanticipated problems, which are caused by diminished oxygen or decreased blood flow to the brain. Treatment options for HIE have been very limited and focused on overall support of the infant with limited neurologic specific therapy. Untreated, HIE can cause permanent neurological problems (developmental problems or cerebral palsy) or death.
Hypothermia treatment has recently been shown to improve the neurologic outcome in some babies with HIE. Induced hypothermia has been shown to be effective in treating adult stroke and heart attack victims and has been used in cardiac surgery for years. Induced Hypothermia therapy for infants has been extensively tested in large clinical trials, both in the U.S. and abroad, and has been shown to significantly reduce the risk of moderate or severe long-term neurologic injury and death. The cooling reduces the energy needs of the brain and reduces ongoing injury.2, 3, 4
Nurses play a crucial role in initiating induced hypothermia. It is often nurses' who recognize that a particular infant meets criteria for induced hypothermia and approaches their physician colleague about the possibility of transporting a baby for this vital therapy. It is therefore important for both nurses who identify babies for therapy, and those who will be caring for them to have an understanding of induced hypothermia.