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Decision making surrounding therapeutic hypothermia


The reviewers found that, at times, the information contained within the local reviews lacked detail on whether or not criteria were met to initiate therapeutic hypothermia treatment.


The reviewers considered that such clinical decisions should be made in the context of readily available agreed best-practice guidance. Clear detail should be included in any review of whether each criterion was being met or not.



A baby was born at 39 weeks of gestation via emergency caesarean section following decelerations and a pathological CTG. At birth, the baby had poor tone and minimal respiratory effort. The investigation report was unclear as to how the decision was made to start therapeutic hypothermia treatment for the baby and the documentation of neurological findings was lacking. The baby received therapeutic hypothermia treatment for 72 hours but the report does not detail a discharge diagnosis and it is unknown on which day the baby was discharged.


Reviewers noted that where babies were being considered for therapeutic hypothermia, staff should consider passive cooling. If so, the baby’s core temperature must be continuously monitored prior to and during passive cooling.

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Decision making around whether or not to treat babies with therapeutic hypothermia should be based on local best-practice guidance.[i]



[i] The TOBY Xe Study. Study Handbook. Version 2; 2012 []