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Therapeutic hypothermia (TH) is the standard treatment for perinatal asphyxia. A Swedish study explores the integration of parent-infant closeness during TH, highlighting the benefits of combining TH with family-centred care. Through interviews with NICU staff in Sweden, the research underscores the importance of standardised routines, supportive care environments, and parental involvement to enhance the effectiveness of TH and improve outcomes for infants and their families.
Understanding therapeutic hypothermia
Therapeutic Hypothermia (TH) involves lowering a newborn’s body temperature from 36‑37 °C to 33.5 °C (96.8-99.5 °F to 92.3 °F) for 72 hours, followed by controlled rewarming. It is the standard treatment for perinatal asphyxia, where a newborn does not receive enough oxygen before, during, or after birth. It could potentially lead to hypoxic-ischemic encephalopathy (HIE), a type of brain damage. TH has been shown to reduce the risk of neurodevelopmental impairment, mortality, and improve cognitive and neural development in infants.
The importance of skin-to-skin care
Skin-to-skin Care (SSC) is essential in stabilising the infant’s physiology, promoting breastfeeding, and fostering parent-infant bonding. However, during TH, where infants are wrapped in a cooling blanket and connected to monitors, SSC is challenging. Parents often feel negatively impacted by physical separation and the high-tech environment. Studies suggest that “Cool-Cuddle”, allowing parents to cuddle their infants during TH, can improve the effectiveness of TH because newborns are kept close to their parents. Additionally, it strengthens the parent-infant bond and positively impacts breastfeeding outcomes.
Challenges in NICU practices
The study involved interviews with staff from 10 of the 22 NICUs in Sweden performing TH. Three key categories emerged: the need for standardised routines, the influence of the care environment on parent-infant closeness, and practices around parental involvement. Staff emphasised the importance of clear, standardised routines, which enhance security, efficiency, and consistency in care. Most NICUs used standardised routines for sedation, pain management, and enteral feeding. Infants with brain damage may not show clear signs of pain or may be more irritable, highlighting the need for an objective, reliable pain scale for newborns. However, this study revealed a lack of such a scale, which is essential for their care.
Optimising the care environment
Not all NICUs could provide single rooms for newborns needing TH, which would be preferrable since the TH equipment consumes a significant amount of space and creates other disturbances. Single rooms offer a quieter environment for parents and infants. Most NICUs allowed overnight stays, but only two could provide single rooms, leading to less privacy and quietness. All NICUs allowed parents to stay around the clock, creating better conditions for the whole family to be together.
Enhancing care with parental involvement
Parents routinely expressed a strong desire to be actively involved in their infant’s care. They also required more information and repetition compared to other NICU parents. Written, standardised information was suggested as a solution. Staff emphasised the urgency of reuniting birthing parents and infants as soon as possible. NICUs made efforts to maximise closeness experiences, such as SSC before TH and immediate breastfeeding after TH completion.
Maximising the impact of TH through family-centred care
The study concluded that TH is most effective when combined with parent-infant closeness and active parental involvement. Achieving this requires comfortable NICU conditions, including single rooms and standardised routines. Alternatives for parent-infant closeness including SSC are needed to prevent parental trauma and ensure effective care for newborns. The study found that standardised routines for care space setup, medical and caregiving approaches, and NICU practices either support or limit opportunities for parent-infant closeness. Integrating TH for newborns with parent involvement can maximise its effectiveness and promote better family outcomes.However, the authors noted that the findings may have limited generalisation due to the small sample size and the unique Swedish healthcare system, which allows parents to be present throughout the hospital stay, covered by insurance.
Paper available at: https://www.sciencedirect.com/science/article/pii/S187757562400065X
Full list of authors: Pyrola Bäcke, Anna Axelin, Johan Ågren, Ylva Thernström Blomqvist
