Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia

Abstract

Objective: To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxic–ischemic encephalopathy treated with moderate whole-body hypothermia. Design: Retrospective study. Setting: Neonatal Intensive Care Unit (NICU). Patients: Thirty-nine neonates cooled in the considered period. Intervention: Starting from January 2008, for neonates treated with moderate whole-body hypothermia (33.5 °C), the cooling system was set in “automatic servo-controlled mode (ACM)”, where the temperature of the circulating water could vary between 4 °C and 42 °C. Starting from January 2009, cooling blankets were used in another type of automatic mode, the “gradient variable mode (GVM)”, where the circulating water was maintained at a specific pre-set gradient towards the patient’s body temperature, and a specific nursing protocol (NP) was adopted. Measurements and main results: Two of the eleven newborns treated with the “ACM” exhibited skin complications compatible with subcutaneous fat necrosis (SFN). None of the twenty-eight newborns treated with the “GVM” exhibited skin complications. A comparison of the biochemical and hematological data between these two groups revealed that newborns treated after the adopting of a NP and the “GVM” showed lower serum protein C and calcium levels, and higher platelet levels. Conclusions: Our data suggest that newborns undergoing therapeutic cooling may benefit from a specific NP and correct cooling unit setting. Should further studies confirm our data, this nursing approach could be easily adopted.

Keywords::

• Asphyxia
• hypothermia
• hypoxic-ischemic encephalopathy
• newborn
• subcutaneous fat necrosis

Acknowledgment

We are most grateful to the nursing staff of Neonatal Intensive Care Unit of A. Meyer University Children’s Hospital, Florence, for their assistance in conducting this study.

Declaration of Interest: The authors declared no conflicts of interest.