Implementation of a Hypothermia Treatment Program for Hypoxic Ischemic Encephalopathy- SCVMC NICU Experience Implementation of this program would not have been possible without extreme dedication of SCVMC NICU staff and families, and support from Santa Clara County First Five and Valley Medical Center Foundation.

HI Primary cell death Cytotoxic mechanisms Delayed neuronal death 6 hoursDays Repair mechanisms Hypothermia 72 hrs Brain injury evolves over time following hypoxic-ischemic insult Epo and other intervention - +

INCLUSION: ≥36wks GA and ≥ 1800gms AND meet both Physiologic and Neurological Criteria EXCLUSION: 1) Lethal Chromosomal or Congenital anomalies, 2) Active bleeding, 3) Severely injured - comfort care Physiological CriteriaNeurological Criteria Cord or Baby’s ABG < 1 hour No gas <1hr OR pH and BD Moderate Encephalopathy 3 of 6 findings below 1. Lethargic 2. Inactive/decreased activity 3. Distal flexion 4. Hypotonia- focal or general 5. Weak suck/incomplete moro 6. Pupil constricted/ Bradycardia/periodic breathing pH ≤7.0 OR BD ≥ 16 Seizure On Clinical Exam or BrainZ A Major Perinatal Event 1. FHR decals, cord prolapse, abruption, uterine rapture, 2. Maternal trauma, hemorrhage 3. Infant CPR in DR AND Apgar ≤ 5 at 10 min or PPV ≥ 10 min Plus OR Severe Encephalopathy 3 of 6 findings below 1. Stupor/coma 2. No activity 3. Decerebrate 4. Flaccid tone 5. Absent suck/moro 6. Pupils dilated /unreactive, variable HR, apnea OR SCVMC Total Body Cooling (TBC) Active Cooling AN D Neurological Criteria Physiological Criteria

Lit. Review Program Set Up Train aEEG “Super Users” First infant Nursing P and P Cooling Equipment Changed Skills Lab Hands-on Staff Ed. Staff In-service HIE and TBC Nursing Medical P and P Revised 2007 Start Data Submission to VON - NER Feb Epo study VON NICQ Encephalopathy collaborative 2011 Completion of Epo study Supper User Skills day 2012 Cooling during transport Trial Bay Area 3 rd Cooling Summit 47 infant

SCVMC Regional NICU TBC Institution (Birth Rate/y) st Q Total VMC (~5000) (1KSC) 7 (1KSC) 34 OCH (~4000) SRH (~1000) Total (~10,000)

QI paper – Pediatrics in press Optimizing Therapeutic Hypothermia for Neonatal Encephalopathy: A Quality Improvement Collaborative Using Potentially Better Practices ¹Steven L. Olsen, MD, ²Mitchell DeJonge, MD, ³Alex Kline, MD, 4 Ellina Liptsen, MD, 5 Dongli Song, MD, PhD, ¹Betsi Anderson, RN, BSN, CPHQ, 6 Amit Mathur, MBBS, MD

Long-Term Neurodevelopmental Outcomes? Evaluation of Brain Injury and Prognosis?