Holding during therapeutic hypothermia

[Lisa]

We are doing. QI project regarding parental holding while being cooled. Do you allow and if so do you have a holding protocol?

[Vicky Payne]

Hmmm, not in my unit (UK). Will be very interested to see what other units do.... but we also don't get babies out for cuddles with umbilical lines in either, and most of our babies having therapeutic hypothermia would have umbilical lines in too. 

Looking forward to seeing others responses....

[ali]

 

Hi Everyone,

Given the infants remain servo controlled in either jacket or mattress and central lines can be visualised (provided no coagulopathy) it seems extremely harsh to ask a parent to not be able to hold their child for almost four days (if you include rewarm period). A study into aEEG response to cuddles might reveal some interesting results??

https://pubmed.ncbi.nlm.nih.gov/30721531/

 

[Stefan Johansson]

We don’t have parents holding cooled infants either. But I like the idea, despite mech ventil, cooling matress, lines etc, why not?

[Kathrynlm]

We have a standard operating procedure that allows holding with specific criteria.   

 

[ppachi]

We don´t do it, because we never though about it; but is something that we must to consider.

Thanks for the idea

[Lisa]

We looked for evidence regarding safety and temperature stability and found one study of 10 infants (no intubated infants) held for 30 minutes on 2nd or 3rd day. There were no adverse events (stable VS, temp, no displacement of umbilical lines or EEG wires) and positive feelings of bonding and connection from moms and nurses  

Craig A, Deerwester K, Fox L, Jacobs J, Evans S. Maternal holding during therapeutic hypothermia for infants with neonatal encephalopathy is feasible. Acta Paediatr. 2019 Sep;108(9):1597-1602. doi: 10.1111/apa.14743. Epub 2019 Mar 5. PMID: 30721531; PMCID: PMC6682469.

We are looking for expert opinions from various centers and plan to do a QI study

Kathrynlm what are your criteria?

Edited July 3, 2021 by Lisa
I accidentally repeated information

[Mo7]

Not in UK or Ireland. In a unit in Canada we tried it but it led to temp stability and the machine working harder to keep temp within the target range

[samik.hiran]

We do, in our unit. No specific guidelines though. We generally encourage cuddles at every opportunity, including in the delivery room.


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[piatkat]

Recently I've participated in a small scientific meeting with the neonatal team from Uppsala, Sweden, and from what I understand they are trying to involve parents in a more meaningful way to care for their infants during therapeutic hypothermia. I know that so far they have published this qualitative study https://onlinelibrary.wiley.com/doi/10.1111/apa.15431 and a bit earlier this study https://pubmed.ncbi.nlm.nih.gov/31084824/ :"Being unable to hold the infant skin-to-skin during HT has been shown to be stressful [10], and although skin-to-skin contact has to be limited due to thermoregulatory constraints, infant holding is indeed feasible [23]." I hope this gives you some fresh perspective

I have no idea if we have anybody from Uppsala here, @Stefan Johanssondo you maybe know?