What criteria do doctors use to decide whether a baby should get hypothermia therapy?

There are many criteria that physicians use to determine whether a baby should get therapeutic hypothermia (brain cooling). Medical professionals first must determine if an infant has hypoxic-ischemic encephalopathy (HIE). This is very important, as medical staff will only provide hypothermia treatment if there is an HIE diagnosis. If medical professionals fail to quickly diagnose HIE, the baby may not receive treatment within the crucial six hours* after the injury. This means that time is of the essence when HIE is suspected.

Medical Staff Must Monitor Newborns for Signs and Symptoms of HIE

There are certain clues or indicators that indicate that a baby may have HIE. These include:

  • Baby needed resuscitation at birth or during the first few days of life
  • Low APGAR scores for more than 5 minutes
  • Seizures within 24-48 hours of delivery, in the NICU, or shortly after discharge from the NICU
  • Difficulty feeding
  • Profound metabolic or mixed acidemia in umbilical cord blood samples
  • Multiple organ issues
  • No brainstem reflexes (breathing issues, abnormal responses to light, or lack of reflexes other than blood pressure and heart function)
  • Coma
  • Hypotonia or abnormal limpness

If these are present, medical staff may conduct further evaluations and assess hypothermia therapy eligibility criteria.

When Should Doctors Perform Therapeutic Hypothermia?

Guidelines for therapeutic hypothermia continue to evolve as research progresses, and exact criteria vary from hospital to hospital. However, the Academic Medical Center Patient Safety Organization (AMC PSO) provided the following general recommendations from a task force on neonatal encephalopathy in 2016:

Therapeutic hypothermia should be given when all three of the following criteria are met:

  1. The baby is less than six hours of age*, and was born after at least 36 weeks of pregnancy.
  2. At least one of the following:
    • A complication before delivery, such as cord prolapse, uterine rupture, or profound fetal bradycardia
    • An Apgar score of five or lower at 10 minutes of life
    • Prolonged resuscitation at birth
    • Severe acidosis
    • Abnormal base excess within 60 minutes of birth, as shown in umbilical cord gas or neonate blood gas
  3. At least one of the following:

Additionally, physicians are advised to consider administering therapeutic hypothermia when all three of these criteria are met:

  1. The baby is no more than 12 hours of age*, and was born after at least 34 weeks of pregnancy.
  2. At least one of the following:
    • A complication before delivery, such as cord prolapse, uterine rupture, or profound fetal bradycardia
    • An Apgar score of five or lower at 10 minutes of life
    • Prolonged resuscitation at birth
    • Acidosis
    • Abnormal base excess within 60 minutes of birth, as shown in umbilical cord gas or neonate blood gas
    • A collapse after birth that results in hypoxic-ischemic injury.
  3. At least one of the following:
    • Signs of neonatal seizures
    • Evidence of neonatal encephalopathy in a clinical exam

*Research Update: Hypothermia Therapy May Be Effective 6-24 Hours After Birth

A recently-published study in the Journal of the American Medical Association (JAMA) suggests that hypothermia therapy may be effective 6-24 hours after birth. Laptook et al. (2017) conducted a randomized clinical trial of infants with moderate or severe HIE. 83 infants were given hypothermia therapy, while 85 were maintained at a normal body temperature (control group). The authors then followed up with these cohorts between 18 and 22 months of age. Their results were non-significant under traditional frequentist analysis, but they suggested that hypothermia therapy may still be helpful more than six hours after birth. Laptook et al. stress that further research is warranted, because an improved prognosis in even a small percentage of patients could be of clinical importance due to the severity of HIE-related brain damage. Moreover, they found “no evidence of commensurate harm” – in other words, the potential benefits of administering hypothermia therapy between 6-24 hours may outweigh the costs.

When Should A Baby Not Receive Therapeutic Hypothermia?

The AMC PSO guidelines state that babies should not receive hypothermia therapy if they were born very preterm (under 34 weeks into pregnancy), and that physicians should exercise extreme caution if they weigh less than 1,750 grams, have severe congenital abnormalities, suffered major intracranial hemorrhage, have overwhelming septicemia, or show evidence for a blood clotting disorder that could make the treatment dangerous.


Talk to Our Trusted Hypoxic-Ischemic Encephalopathy Attorneys for Legal Help

The attorneys at Reiter & Walsh P.C. focus only on birth injuries — we are one of the few firms in the nation that does, and have a particular focus on hypoxic-ischemic encephalopathy and therapeutic hypothermia. This narrow focus has allowed us to develop an extensive knowledge of both the medical and legal aspects of birth injury law, amassing a long track record of successes in representing our clients. If you believe your baby needed therapeutic hypothermia and did not receive it, or needed brain cooling due to a medical staffer’s mistake, reach out to the birth trauma professionals at Reiter & Walsh P.C. to receive a free case evaluation.

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Related Resources | Birth Injury and Seizures After Birth


Infographic: Therapeutic Hypothermia

What is therapeutic hypothermia?


More Information on Hypoxic-Ischemic Encephalopathy (HIE)

More Information on Hypothermia Therapy (Brain Cooling)