Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Admission Evaluation

The current neurologic status of the infant should be documented on arrival as this exam is variable and time to normalization can help predict future developmental outcomes. However, a normalized exam should not exclude an infant from treatment with therapeutic hypothermia if the exam at the referring hospital was abnormal and other eligibility criteria have been met.

Physical Exam	Vital signs Eligibility Criteria Review current PIV access Neurological Monitoring Document in Epic Use dot phrases “.hieexam” “nicuhieexam” or “.nicuneurohie”
Obtain/Review Labs from Transferring Institution	CBC w/differential PT/INR PTT Profile Type and Screen Hepatic Function Tests POC ISTAT BGP 7 POC Glucose — Every 4 hrs x 4 Every 8 hrs until 72 hrs
Esophageal Probe	Place temperature probe Placement of an Esophageal Temperature Probe
Imaging	Chest X-ray AP or PA After insertion of document temperature probe to distal 3rd of the esophagus
Fluids/Nutrition	D10W at 60 mL/Kg/day
EEG	Obtain EEG Guidance for Treatment of Neonatal Seizures EEG Monitoring Pathway
Medications	At discretion of treating team, consider initiation as clinically indicated Antibiotics Anti-seizure medications
Consults	Neurology — ICU Neurology Team at CHOP or as arranged for each site Physical Therapy

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Admission Evaluation

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Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway, ICU – Admission Evaluation

Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Admission Evaluation