Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway, ICU – Referring Patients

Hypoxic-Ischemic Encephalopathy (HIE) Clinical Pathway — ICU

Referring Neonates, Neonatal Consultation and Care Prior to Transport

  Interventions
Referring Neonates
  • For neonates possibly eligible for neuroprotective care
    • Contact CHOP Emergency Transport, 215-590-2160
    • Discussion with CHOP Neonatology as needed
  • Provide
  • CHOP referring/receiving clinicians
    • Use Epic dot phrases “.hieexam” or “.nicuhieexam” to assist with documentation
Preparing for Transport
  • Consent
    • Discuss possible transfer with parent
    • Obtain consent, send consent with neonate
  • Prepare neonate information
    • Medical Record
    • Radiology disk (if applicable)
    • Request placental pathology (if possible)

Guidance for Initial Care Prior to Transport

  • Early recognition of infants with HIE who may benefit from neuroprotective care is important
  • Treatment interventions should be initiated as soon as diagnosis of HIE is established
  Interventions Comments
Temperature
  • 35-35 6/7 wks:
    • Target body temperature 37°C
  • ≥ 36 wks:
    • Set radiant warmer to 35°C ISC skin temperature
    • Goal 34-35°C
  • Avoid overheating with excessive blankets/hats after resuscitation
  • Check axillary temperatures frequently i.e., every 15-20 mins
    to monitor
IV Access Place PIV UAL, UVL if time permits
do not delay transport
Laboratory Studies
  • Obtain
    • ABG, blood glucose, iCa
 Ideally, within 1st hour of life
IV Fluids Start IV fluids of D10W with a TFL of 60 mL/kg Avoid excessive intravascular volume administration once it is determined that the infant’s intravascular volume is replete and adequate
Antibiotics Consider antibiotics as clinically indicated  
Seizures Guidance for Treatment of Neonatal Seizures
  • EEG monitoring as available
  • Document any clinical seizures