Therapeutic hypothermia for neonates with sudden unexpected postnatal collapse

SCENARIO A 36week gestation infant was delivered vaginally to a primipara with uncomplicated antenatal period. The baby was well following delivery and was admitted to the postnatal ward with the mother. At 2 hours of life, a registered nurse attended the mother and baby for routine care and found the newborn on mother’s chest, in the skintoskin position, with no spontaneous respiration. The baby was bradycardic and required full resuscitation including intubation and cardiac massage. The heart rate normalised but respiratory effort remained poor and ongoing ventilation was required. She was noted to be encephalopathic with an abnormal neurological examination. The patient was transferred to the neonatal intensive care unit following stabilisation and, after discussion with the parents, initiated on therapeutic hypothermia (TH). No apparent cause for the significant collapse was found; there was no pneumothorax, ECG and echocardiography were normal, septic markers and metabolic workup were normal and amplitude integrated EEG did not indicate seizures. The 72hour TH protocol was completed and the patient was clinically well following rewarming. MRI brain did not show significant abnormalities and the baby was subsequently discharged. She continues to be followed up for neurodevelopmental assessment as an outpatient.