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Therapeutic hypothermia can be induced and maintained using either commercial water bottles or a "phase changing material" mattress in a newborn piglet model.
  1. Sachiko Iwata (sachiko327{at}orbix.uk.net)
  1. Academic Neonatology, EGA Institute for Women's Health, University College London, United Kingdom
    1. Osuke Iwata (o.iwata{at}orbix.uk.net)
    1. Academic Neonatology, EGA Institute for Women's Health, University College London, United Kingdom
      1. Linus Olson
      1. Dept of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
        1. Andrew Kapetanakis
        1. Academic Neonatology, EGA Institute for Women's Health, University College London, United Kingdom
          1. Takenori Kato
          1. Academic Neonatology, EGA Institute for Women's Health, University College London, United Kingdom
            1. Samantha Evans
            1. Academic Neonatology, EGA Institute for Women's Health, University College London, United Kingdom
              1. Yuko Araki
              1. Centre for Bio-Statistics, Kurume University School of Medicine, Japan
                1. Tatsuyuki Kakuma
                1. Centre for Bio-Statistics, Kurume University School of Medicine, Japan
                  1. Toyojiro Matsuishi
                  1. Center for Developmental and Cognitive Neuroscience, Dept of Pediatrics, Kurume University School of, Japan
                    1. Fredrik Setterwall
                    1. Dept of Chemical Engineering, Royal Institute of Technology, Stockholm, Sweden
                      1. Hugo Lagercrantz
                      1. Dept of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
                        1. Nicola J Robertson
                        1. Academic Neonatology, EGA Institute for Women's Health, University College London, United Kingdom

                          Abstract

                          Background: Therapeutic hypothermia is a safe and effective therapy for neonatal encephalopathy in an intensive care setting; development of simple and safe cooling methods for use in low-resource settings may increase the number of infants likely to benefit from therapeutic hypothermia.

                          Aims/Methods: To assess two low-tech, low-cost cooling devices: (i) commercially available water bottles filled with tepid water (25°C); (ii) phase changing material (PCM) with a melting point 32°C (PCM works as a heat buffer at this temperature). Eleven anaesthetized newborn piglets were studied following transient hypoxia-ischaemia. The cooling device was applied between 2-26h after hypoxia-ischaemia with the target rectal temperature (Trectal) 33-34°C. Trectal undershoot was adjusted using cotton blankets; the cooling device was renewed when Trectal rose above 35°C. Trectal data during cooling were dichotomised (within or without target) to assess the: (a) total period within target Trectal range; (b) stability and fluctuation of Trectal during cooling.

                          Results: Therapeutic hypothermia was achieved with both water bottles (n=5) and PCM mattress (n=6). The time to reach target Trectal was (i) water bottle: 1.8 (0.5) and (ii) PCM: 1.9 (0.3)h (mean (SD)). PCM cooling led to a longer period within target Trectal (p < 0.01) and more stable cooling (p < 0.05). Water bottle cooling required device renewal (4 of 5).

                          Conclusion: Simple, low-tech cooling devices can induce and maintain therapeutic hypothermia effectively in a porcine model of neonatal encephalopathy although frequent fine tuning by adjusting the number of blankets insulating the piglet was required to maintain a stable temperature. PCM may induce more stable cooling compared with the water bottle.

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