National Institute for Health and Clinical Excellence (NICE)
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Brain cooling for newborn babies improved following NICE guidance

A project to improve the care of newborn babies with brain injury has seen dramatically improved results, after championing NICE's guidance on therapeutic hypothermia.

Babies who are deprived of oxygen around and during the time of birth can develop hypoxic ischaemic encephalopathy (HIE) - brain injury leading to death or permanent disability.

Until recently, there has been no specific treatment for babies with HIE. However, research shows that cooling the body temperature of babies within 6 hours of birth - therapeutic hypothermia - leads to a significant number of babies showing normal development at 18 months, who would have otherwise have developed brain injury.

NICE produced guidance on therapeutic hypothermia in May 2010. It says the procedure is safe and effective in certain circumstances among carefully selected newborn babies, and can lower the chance of developing severe brain damage or death.

This guidance was adopted by the East of England Neonatal Neuroprotection Project in a drive to improve the care of babies with HIE. It has since found its service to be safer and more effective.

Early on in the project, the team undertook a study of all 19 neonatal units within the region. It found that only 4 of the units were able to monitor the temperature of babies' bodies, as recommended by the NICE guidance.

The project carried out a range of tasks to help improve this including developing training packages, identifying learning needs for staff, creating a more standardised imaging practice and developing a neuroprotection care pathway.

Following these actions, the team found improved results in a range of areas, such as an increase in compliance of monitoring body temperature from 0 to 100 per cent.

Other improvements include a reduced time of referral, earlier age at which cooling is started, reduced time in reaching target temperature and increasing the number of babies reaching target temperature within 6 hours from 36 per cent to 100 per cent.

Dr Topun Austin, Consultant Neonatologist at Cambridge University Hospitals NHS Foundation Trust, said: "NICE's guidance provided a strong framework for developing the regional service, collecting data and ensuring babies were cooled safely.

"At the start of the project very few units were using rectal probes - currently 100 per cent are. NICE's guidance was seen as a key 'independent' set of recommendations to benchmark care against."

He added: "We are confident that as a result of this project we are now cooling infants who otherwise would either not have been cooled or been cooled in a non-optimal way, for example through unstable temperature and/or a delay in starting cooling.

"These improvements are likely to have prevented serious disability in a significant number of children, as well as limiting the personal effect on the patient and their family.

"We expect the improvements have also had a substantial economic impact, as the lifetime cost of looking after a significantly disabled child can be between £5-7 million."

NICE's interventional procedures programme considers the safety and effectiveness of a procedure, and whether special arrangements are needed for patient consent. All the interventional procedures guidance published so far is available on our website.

Sharing your story of putting NICE guidance into practice can give you the chance to present your work at the NICE annual conference in May 2012.

The closing date for submissions to be considered for the 2012 Shared Learning Awards is today. However, submissions will continue to be taken for consideration in next year's awards.


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