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amplitude-integrated electroencephalogram (aEEG)

(Fig. 45.1)

If aEEG is unavailable or not used as entry criteria

(2), offer therapeutic HT to infants satisfying criteria a,

b, and c or d.

B. Contraindications

1. Major congenital anomalies. However, local guidelines

might differ. Some centers offer therapeutic HT to term

infants with surgical, cardiac, chromosomal or sudden

unexpected postnatal collapse, who have suffered significant perinatal asphyxial encephalopathy and whose

intensive care will be continued (e.g., infant with surgical condition, ventilated asphyxiated infant with tracheoesophageal fistula requiring imminent surgery)

(7), have a cardiac condition (e.g., infant with transposition of great arteries with tight atrial septum leading to

hypoxic-ischemic encephalopathy), have a chromosomal condition (e.g., infant with trisomy 21 with perinatal asphyxia), and infants suffering postnatal collapse

(e.g., sudden unexpected neonatal cardiorespiratory

arrest leading to hypoxic-ischemic encephalopathy)

unless HT might adversely influence the effect(s) of

other required treatment (8).

2. Syndromes involving brain dysgenesis

3. Infants in moribund state.

C. Cooling at Birth

If the infant fulfills criteria (b) in Section A by 10 minutes

of age, initiate passive HT.

a. Switch off heater in the Resuscitaire/transport incubator.

b. Do not wrap or cover the head with hat (9).

c. Insert rectal or esophageal temperature probe as early

as possible.

D. Cooling During Transport

1. Refer the infant to a center offering therapeutic HT as

soon as possible.

2. Provide the required cardiorespiratory support, and use

passive or other (see G–I) cooling method to achieve

the target temperature early and maintain target temperature during transport (10).