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

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....

 

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/

 

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

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

 

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

Thanks for the idea

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, 20214 yr by Lisa
I accidentally repeated information

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

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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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?

11 hours ago, piatkat said:

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

Unfortunately I don't know about any active members from Uppsala, lets see if we can get someone involved from there. I don't know the last author of these two papers but saw her email was ylva.thernstrom_blomqvist@kbh.uu.se

We do this in theory, (northern ireland, UK) as in, it is written in our guideline that it's a possibility, however, it's yet to happen as babies don't come out of the incubator with umbilical lines. But IF we do have a baby without a uvc in, then we could. Happy to send guideline, the holding part is minimal though. 

I would love to see guideline. Email lisa.roth@ssmhealth.com We don’t encourage holding babies with umbilical lines but do allow holding only under the right circumstances (haven’t allowed cooling babies yet but we plan to start), the baby must be stable and usually the bigger babies. 

Saw this and thought of this thread!! Might be worth trying to link up with the researchers about this!

 

This sounds doable, we do not practice this at our unit, but it's because no one has thought to consider it as an option. How will this work with the CFM on, it will pick up all the movements from baby and parent interacting with baby? False positive readings? Or am I just being OTT. I would also love to see the guideline beyaoby.bonse@nhs.net 

We have only had one infant held so far and it went well—no temperature or vital sign instability. The baby was pretty stable and not on a vent but had umbilical lines. There didn’t seem to be a problem with the vEEG wires. We don’t have an actual protocol for this but with our project, the baby must be stable and is held for 30 minutes with vital signs and temperature from the monitor recorded every 5 minutes. It was the father who got to hold as the mother was still at the birth hospital after a C section. We are a children’s hospital so all of our babies are transported in, a definite disadvantage for C/S moms though they can see their babies 24/7 with the bedside camera and sometimes get a pass to visit day or 2 after birth. 

I haven’t heard about cool cuddle in Spain. I feel it is doable in NICU with care. I see as a way humanize care and allow parents to bond with their babies.

I work in the NW of the UK. Over the past few years we have got a few babies out for cuddles who were not ventilated and did not require cardiovascular support. These are babies with a more mild disease. They were all on servo- controlled mattresses and we had no adverse events.

On our unit having umbilical lines in would not prevent cuddles, we just ensure that there is an extra nurse to support moving the baby.

Since we started getting babies out for cuddles one of my consultant colleagues was not happy to extend cuddles to those who were ventilated.

Having said that we have got babies out for cuddles requiring full intensive care once we have started the conversations about reorientation of care. Again we have had no incidents, 3 nursing staff were involved in all moves.