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Holding during therapeutic hypothermia


Lisa

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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....

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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/

 

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Posted (edited)

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 by Lisa
I accidentally repeated information
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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

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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?

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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

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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. 

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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. 

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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 

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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. 

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