Treatment// Cooling therapy// OUTCOMES and recovery after HIE?!!

[@ltlbw4442]

Excellent video presentation and very informative. You are a great educator and I look forward to learning more through your future videos.

[@TalaTalksNICU]

Thank you so much Latoya! Very grateful for your positive words!!!

[@EBaileyBennett]

As a HIE mom, thank you. I was overwhelmed with information the day of my sons birth. It was so nice to watch this in terms I understood.

[@TalaTalksNICU]

Dear Bailey, we're so sorry you had to go through that. We're happy the video provided some understanding at least. Good luck with your little man XXX

[@teresacaldeira9023]

Hi Dr Tala I'm a portuguese Neonatologist with 15 year's experience NICU that just arrived in Saudi Arabia to work in an american-based, totally diferent system. You're talks helped me a great deal to adjust. Thank you!

[@TalaTalksNICU]

Congratulations on your new role! So glad these videos are helpful in some way! Hopefully all the NICUs aren't too different! We've been trying to collect where everyone is watching from- so I think I'm going to cheat slightly and include Portugal and Saudi! ha! Good luck with your new job-I've been hearing fantastic things about Saudi recently - loads of growth etc.

[@laurazacharias210]

So grateful for all your videos!! We’ve been getting a ton of cooling babies lately and I love listening to your videos to learn more and refresh my knowledge

[@TalaTalksNICU]

I’m sorry you’ve had a run of HIE babies :( happens like that doesn’t it? Thanks so much for watching and for being here :)

[@HopeforHIE]

Here to support with you! ☀️🩵

[@TalaTalksNICU]

@HopeforHIE you are all amazing- in awe of what you are doing xx

[@ktwigginton2805]

I had a placental abruption and my baby was cooled. I fully believe it saved his brain. He is about to turn one and you’d never know he had such a hard start!

[@TalaTalksNICU]

That's amazing KT. Honestly, we feel like we've seen actual miracles with cooled babies. The deficiencies that developmental doctors are seeing now are way lower than before the cooling days. Congratulations on your little man-enjoy this year! I LOVE one- year olds!!!

[@maryambaj9901]

Thank you for making everything in NICU sound simple ❤

[@TalaTalksNICU]

Oh yay! That was our goal all along- thank you!

[@lekhajose2375]

Hi Dr Tala, all your talks are very informative and very easy to understand.Thank you for educating us and I wish I had a chance to listen to your talks few years ago when I started my job as a NICU nurse.

[@TalaTalksNICU]

Thank you so much for watching! Arianna and I said same thing- we wish we'd started a couple of years earlier! But we're enjoying it now!! Thank you again Lekha :)

[@lenaalsaleem3769]

Thank you for your highly beneficial videos! I would like to learn more about inotropes and cardiovascular support and monitoring in NICU setting. Thank you!

[@TalaTalksNICU]

YES! we need to cover these soon- thank you so much for being here and for taking the time to comment!

[@nadevi92]

This lecture was so well explained!! like all of your lectures pretty much. I really enjoyed this.

[@TalaTalksNICU]

Thank you so much for letting us know! So happy you enjoyed it!

[@reese1386]

We were told our grandson has brain damage from breaking away from the placenta. Hes 2mths old and hasn't opened his and is still on a ventilator. We're all are so hurt. We need more help please. Payers for Nolan.

[@reese1386]

I apologize. He hasn't opened his eyes yet

[@TalaTalksNICU]

We're so sorry to hear about your grandson. All we can say is that babies are very resilient. We hope for the very best outcome Nolan's doctors have suggested he may have. Good luck XX

[@driamarshell]

Amazing video!! You made it so much easier learning about the HIE process and cooling treatment🙌🏽💐

[@TalaTalksNICU]

Oh thank you! So happy you found it simplified - always our aim

[@crystalumar9423]

Hi Dr. Tala and team, amazing content as always😊...would love to hear about congenital heart anomalies and neonatal sepsis. Thank you for the great work 🥰

[@TalaTalksNICU]

Hello Crystal- thanks for watching and for your positive words! We plan on starting a congenital heart disease series soon when we're past our back-log of requests! And we will film sepsis- I think we've avoided it so far because it's more facts rather than explanations- but obviously it's probably the most important subject for us to cover! Thank you again!

[@ahmedelbahtiti586]

Hi Tala. Thank you very much for this easy simple explanation for HIE and cooling therapy

[@TalaTalksNICU]

So glad you found it simple- that's our goal! Thanks for taking the time to write to us :)

[@katchreen680]

Thank you Tala for your videos . Definitely informative . Easy to understand .

[@TalaTalksNICU]

Thanks so much for watching and for letting us know Katch!

[@dipikadave7533]

Hello Miss Tala , thank you very much for sharing knowledge.being a NICU Nurse it is very helpful for me to understand all about HIE ,if you can guide us for nursing care during therapeutic hypothermia.Where I am working there is a facility of therapeutic hypothermia.I am from India and I am working under Dr.Somashekhar Nimbalkar member of NNF.Thank you Miss Tala

[@TalaTalksNICU]

Hello Dipika- that's so great you work somewhere with cooling therapy- it's really nice not separating these babies from their mothers. This would be a great idea for a video- we have to figure out how we can do this most helpfully without actually filming a baby at bedside :)

[@gaitreeoree3928]

Hello. Please kindly consider a lecture on Hypotension -(diastolic & systolic), choice, and reasoning for use of the different inotropes in neonates. Thank you very much:)

[@TalaTalksNICU]

Hello Gaitree! This is an excellent suggestion!!! We will add this to the list and get around to it sooner rather than later! Thank you!

[@deebutler9813]

Thanks Tala! Appreciate your videos. So easy to understand.

[@TalaTalksNICU]

Thanks so much Dee! We're aiming for ease- so that makes us so happy!

[@DaniMezgebe]

Thank you very much!!!!! Your lectures are very clearly presented and very helpful!!!

[@TalaTalksNICU]

We're so happy Dani! Thanks so much for reaching out and letting us know. We're so glad they're helpful :)

[@jampellhendrup1376]

Thank you Dr Tala for enlightening me on therapeutic cooling. I never miss your tutorial videos. Very helpful. I have 2 questions: 1.Can we breastfeed (EBM) during cooling period? 2. When the baby is cooled to as low as 91°F for 72 hours, will the infant not die of hypothermia?

[@TalaTalksNICU]

We're so happy these videos are helping you! Thanks so much for your support :) So- two excellent questions- 1) We generally don't directly breast feed during cooling for two reasons. a) It would be difficult moving the baby around and maintaining the correct temperature and not stimulating the baby too much and b) we're worried about the coordination the infant has when he's being cooled (i.e. if doesn't have a good suck/ gag reflex, has a much higher chance of choking). More recently however we have started giving feeds down a gavage tube into the stomach- (from the nose or the mouth)- not full feeds- somewhere between trophic feeds and say 40ml/kg/day. If the baby is stable enough to start feeds (i.e. not hypotensive or in severe respiratory depression), then this helps stimulate the gut in the future. 2) The babies are cooled to between 33.5-34.5 degrees celcius- so that's a little higher than 91 on Farenheit scale (~93.2). Overall- infants that were cooled had decreased death and worsened developmental outcomes so in the right group there is decreased mortality not increased. However- as you well realize, in premature babies, being hypothermic definitely decreases mortality. That's why we don't generally cool babies

[@jampellhendrup1376]

@@TalaTalksNICU thank you 🙏

[@laradevaal8045]

Dr Tala, I have a very important question, probably the most important you’ll receive this whole day: How do you find the time to reply to each comment? That’s amazing. I’m a med student and I feel like I barely have time to eat food.

[@TalaTalksNICU]

Hahahaha! I think when I was a med student it was the time of my life when I had very little outside interests. I just studied and studied and studied! So I get where you’re coming from! But it’s all worth it- build the best foundation you can now!!!! This will pass!! And for the rest of it- it’s actually quite selfish- because I love these comments so much! (Yours made my day when u read it yesterday!). Most of the time it takes under a minute to reply so that’s like max 10 minutes a day! Sometimes I reply while waiting for an elevator or while waiting in car pool to pick my kids up. But thank you! For being here- for recognizing how time consuming everything is and for taking your own time to comment!! Good luck xxx

[@laradevaal8045]

@@TalaTalksNICU Thank you for the encouragement, hearing it from from someone who has made it through to the other side and saying it is worth it is quite inspiring. Keep up the great work, Dr Tala, we appreciate your content.

[@ninabakker7768]

Hi there, Thanks a lot for your explanation about this subject. As a nurse in study for becoming a NICU nurse i would love to have more clear information about how HIE can result in cerebral edema. It would be amazing if you could explain that in a video :). Anyways, thank you for all the videos i have already seen before.

[@TalaTalksNICU]

Hi Nina! There are really two main culprits of cerebral edema- the first is acute- when all the transporters/channels in the cells breakdown (because they lack energy) and so too much fluid seeps inside the cells. Then- there's a gross accumulation of fluids within a few hours for two main reasons: the kidneys generally aren't functioning well, so water is retained, and two- with brain injury, there is generally some level of SIADH (syndrome of inappropriate anti-diuretic hormone secretion)- which causes even more fluid retention- everywhere- including the brain. Does this answer the question adequately?? Thanks for commenting!

[@pip1307]

Great video! Would love to see one on EEG/Brainz monitoring/seizures. 😊

[@TalaTalksNICU]

Hello Pip- sorry answer took so long. We promise we'll get around to this soon! Thanks so much for the suggestion and for watching :)

[@havvasimsek6419]

I watch your videos repeatedly and find them really useful. Thank you so much. Is it possible to make videos about mechanical ventilation types . Thank you

[@TalaTalksNICU]

Thank you Havva! we have missed your comments :) We are doing one last video on treatment of jaundice and then we'll go back to mechanical ventilation (high frequency/ CPAP etc.) We hope you are well - and thanks again for continuing to watch!

[@nashwaelhenawy3880]

Thank you so much for your amazing sessions, I am a neonatologist and I wanna more sessions about, GERD,

[@TalaTalksNICU]

Thank YOU so much for watching. GERD is a great plan- look forward to delving into a recent literature review. As you know- it's such a frustrating problem!!! Thanks again for being here :)

[@aminasaleh7872]

Really thank you🌷, can't wait for the next topic.

[@TalaTalksNICU]

Thank you so much for continuing to watch and comment!

[@through_Ameera_]

keep explaining the facts in fun way #nainann

[@TalaTalksNICU]

Thank you so much! That is absolutely our intention!

[@Nicole-so4zv]

Thanks for the great video! A suggestion: Would it be possible to add timestamps to the video in the description box so that when I come back to review I can find the part of the video I'd like to review more quickly? Thank you

[@TalaTalksNICU]

Hi Nicole! Thanks so much for watching and giving us great advice! Can we ask you how specific you'd like the time-stamps? Like 3-4 a video or more than that? Thanks so much for asking for this- it hadn't occurred to us at all- and that would be very useful!

[@Nicole-so4zv]

It would be great to have a timestamp for each topic that is covered in the video. For this video there were 5 topics that were outlined, so a timestamp at the beginning of each of those topics would be great. I love these videos, thank you guys so much!!

[@TalaTalksNICU]

Perfect Nicole! That's such great advice- we'll go back and do this on the previous videos too. Thanks again!

[@vickiewinner5739]

I would love to hear one about AKI. For example, how to treat high K levels with CBIG and the pathology behind it.

[@TalaTalksNICU]

Hello Vicki! We can definitely talk about high potassium, and its treatment. I'm not familiar with the acronym though- and I can't figure out what it refers to! Would you mind letting us know!? Thanks so much!!!

[@vickiewinner5739]

@@TalaTalksNICU It just a pneumonic to remember tx for hyperkalemia (C BIG K DI): C- calcium gluconate, B- Beta2 agonists, IG- Insuglin +Glucose, K- kayexalate, DI- Diuretics

[@TalaTalksNICU]

Oh I love that!!!!! Will do the lecture and include that (and you!) We're in the middle of recording a series on gases now, but I think I'll break away to start the electrolyte series for a change :) Thanks so much!!!!

[@jedidah_evelyn_mukumbo]

Thank you for these videos ❤enjoying them ❤❤❤❤❤

[@TalaTalksNICU]

Thank you so much for taking the time to write. So happy you’re enjoying them :)

[@numnumtv1]

thank you so much for ur awesome videos..

[@TalaTalksNICU]

Thank you so much for being here and taking the time to comment!

[@katherinerubio2750]

Thank you SO MUCH for your videos

[@TalaTalksNICU]

Thank you so much for watching and for taking the time to comment :)

[@tracyhansen3067]

Wonderful video. Thank you. Why is esophageal placement of the core probe more common than rectal? When would rectal placement be preferred?

[@TalaTalksNICU]

Hello Tracy! Both techniques measure core temperatures well (as long as rectal probe inserted deeply enough). Different hospitals pick one or the other. I have always worked places that use esophageal probes. We do have to check correct placement with X-rays- but usually you're getting one anyway for lines etc. One can't really make the argument that you use a rectal probe when an esophageal probe can't be used (e.g. an esophageal atresia or a really bad Pierre Robin) because you probably wouldn't want to be cooling these infants in the first place. Great question! Thank you!

[@docNICU]

thanks for the very informative videos on neonatology, i wonder, what u do with babies on cooling therapy whose heart rate is less than 80 and the blood pressure is normal and there are no signs of poor perfusion.

[@TalaTalksNICU]

Hello! Great question. Per the cardiologists, if an infant is born with a heart block, then generally if the rate is above 60, there should be sufficient cardiac output to satisfy metabolic demands. So generally, if the heart rate were lower, as long as the blood pressure is normal and the perfusion isn't worsening (perfusion always pretty bad in freezing babies), we would accept it. Thanks for commenting!

[@daintyragasa1111]

thank you so much. can you also lecture about acid base balance, abg interpretation and babygram?

[@TalaTalksNICU]

Hi Dainty! Absolutely! Many people have requested this topic- so that's going to be our next series of lectures. A couple on the basics and then lots of videos on examples. Hopefully it will be helpful :) Thank you!!

[@fek6878]

What if your health care facility does not have cooling therapy devices? Should the neonate be passively cool and transferred asap? Just curious about how to properly approach a situation. Thanks.

[@TalaTalksNICU]

This is such a good question and we talk about it all the time! Obviously if baby needs to be cooled then the sooner the transfer the better. And then whether you start passive cooling is a decision you need to make in your hospital. The concern is that when no heat is given/ these babies can plummet down to temps that are super low (like unreadable low) - so that’s the risk. If your team makes the decision to do that then very close monitoring is needed. Transport cooking blankets are available so as soon as a medical team arrives- the hope is that cooling can start then. The other thing is even if you decide not to cool the baby passively- make sure the baby never gets too hot. This is also really bad!!! Hope this helps!

[@drazam325]

Thanks tala, great informative

[@TalaTalksNICU]

Thanks Azam for your continuing loyalty! We really appreciate you :)

[@Not_Juliana-w5v]

Thanks TALA ...like every time pleasing us by your educative video🥰.. I would like to know when should I discontinue cooling therapy..many thanks

[@TalaTalksNICU]

Hello Selsabil! Infants are cooled for 72 hours, and then rewarmed slowly over about 6 hrs. Does that answer the question? Thanks so much for watching!

[@Not_Juliana-w5v]

Thanks tala ..but I meant discontinuing during that 72h.. for example if the baby develops severe bleeding or bradycardia or??

[@TalaTalksNICU]

Hello Selsabil- excellent question. The only infants I've seen taken off cooling are ones who we can't oxygenate because of worsening PPHN (and it's been a couple in 15 years). Bradycardia doesn't generally end up as an issue because in the 80s, cardiac output should be sufficient. With bleeding- we still start with platelets, FFP, cryo. etc. and normally that helps. I have not had to stop cooling ever because of bleeding. Sorry I didn't understand what you were asking earlier!

[@amazingvideos2262]

My baby has stage 2 hie. We have been discharge by the hospital after 4 days of treatment. My question is upto what time we should give cooling therapy. My baby is silent all the time not crying. Tnk u mam.

[@TalaTalksNICU]

I'm sorry about the tough delivery :( Cooling therapy needs to be started within 6 hrs of baby's life and then continued for 72 hrs total. I know nothing about your baby- but sometimes babies don't cry a lot. As long as he is sleeping and eating and having periods of awakeness then we wouldn't worry as much about the crying.

[@foreverhopefulCanada53]

My baby had moderate HIE consistent with sarnet scores. But Apgar and thompson suggest he had mild. As per MRI he had small focus of white matter injury in deep right posterior lobe alongwith the mild ivh and hemorrahge also mild edema. Based on his discharge the prognosis was good and positive. I am unable to understand whether it was a moderare HIE or mild. He is one month old and doing verry well. I m just scared about his future.

[@TalaTalksNICU]

Stay optimistic!!! Obviously I can’t speak to your baby but it sounds good. We now realize how much the post- discharge period is probably as important as the NICU stay- so just keep reading and stimulating and loving him!

[@songsalon7868]

Smart Doctor

[@TalaTalksNICU]

Thank you!!!

[@Monica_29]

Thank you!

[@TalaTalksNICU]

Thank you so much Monica!

[@mohammedmaheer4740]

Excellent

[@TalaTalksNICU]

Thank you so much for watching and for taking time to comment!

[@gabypleasant]

awesome thanks!!

[@TalaTalksNICU]

Thank you for watching - and thanks so much for subscribing GM :)

[@khalidkhankhalidkhan9985]

Hi Dr Tala.. My baby have HIE and cooling therapy not done. Now he is 2months old and have fits and poor sucking, chest infection also.. What treatment you suggest for him. Please help me thank you

[@TalaTalksNICU]

Hello- we are so sorry you are going through this. Obviously since we are not taking care of the patient, it's very difficult to truly understand what is going on. It's great you are an advocate for your child- we are sure your team is taking care of his needs. Good luck

[@sifnamoljoseph85]

Thanku good explanation

[@TalaTalksNICU]

So glad it helps! Thanks for taking time to write

[@masaderrick6387]

Dr tala recommend the best pediatrics books please

[@TalaTalksNICU]

Hello! Even though I'm a board certified pediatrician, I haven't read actual pediatric books since my boards. We could give you some neonatology recommendations though!!

[@hassanfarah9883]

thank you dr tala for your amazing lecture, i would like to ask you if neonate has hydrocephalus with seizures and then we started phenobarbital and seizures has decreased but still present and then was done for shunting, now the baby seizures has almost controlled and head size is decreasing and he is on 4 month of life can we continue phenobarbital or switch to another antiepileptic drug. my point is does phenobarbital has any effect on the developing brain of the baby

[@TalaTalksNICU]

OHH that's a tough one. I feel like neurologists continue AED for different periods of time. If infants are stable in the NICU and had a distant history of seizures (e.g. from an IVH) then I try to stop meds while the infant is in the NICU before they go home (because then we can watch to see whether they need it or not). The infant would still be at risk for dealing seizures in the future though. Any medication we can get rid of would be better. There is some increasing concerns with phenobarbital (www.ncbi.nlm.nih.gov/pmc/articles/PMC4000307/pdf/nihms515167.pdf) but obviously nothing is worse for the brain than uncontrolled seizures. Sorry if that wasn't very helpful!

[@jfcdisguy]

Is it possible for a baby with HIE Moderate who showed symptoms of HIE such as hypotonia and asymmetry to have a normal outcome with therapy?

[@TalaTalksNICU]

We use the term normal very loosely- in reality a lot of people have slight weakness on one side, or slight deficiencies in very specific cognitive tests (eg visuospatial or whatever). There is a very good chance that a baby with moderate hypotonia who was cooled will have an excellent quality of life, in the right grade at school and on sports teams! And as parents - what we always worry about- the ability to be happy and live a pain free life!

[@jfcdisguy]

@@TalaTalksNICU Thank you so much. My baby caught up with her age group when she was 9 months old, though she still exhibits slight asymmetry (she prefers to pull to stand relying on her right foot, though she can do in on the left too if I force her) and her head flops back for a second when I lift her up from lying on her back even though she otherwise has good head control (can sit, crawl and stand normally). Her MRI showed grade 2 damage though.

[@agnesmarlow1799]

Can Dr Tala us e a talk on fluid homeostasis in premature infant. Please

[@TalaTalksNICU]

Hello Agnes- we promise it's coming soon! After NEC!!! Thanks for your suggestion :)

[@mashamadevents1397]

Hi! What process would the hospital run to fine out if your child has HIE or not? What is a typical lever panel numbers in a child with HIE? Thank you

[@TalaTalksNICU]

Hello Masha, we're sorry you're going through this. HIE is mostly a clinical diagnosis (you need a history and an abnormal neurological exam). In addition, there should be acidosis on the initial blood gases. Sometimes an MRI will show evidence of ischemia (or other changes), although this isn't always the case. The liver may have abnormally high numbers (e.g. AST and ALT > 100 range), although again, this isn't always the case. Also many processes may increased the liver function tests. We hope this helps!

[@karllloydlicup8529]

Is there a cut off of pH on the blood gas when it is deemed necessary to defer passive cooling or other forms of therapeutic hypothermia since as we know hypothermia is usually detrimental to most of our sick neonates as it is very well known to cause metabolic acidosis?

[@TalaTalksNICU]

Hello! No there really isn't an absolute number. I think this goes so much more with the clinical picture. I'm sure you've gotten gases that are like 6.8 and you're still like "the patient doesn't look too bad", and it turns around quickly. So really there isn't a minimum- it's more about clinical picture. (If infant limp, no reflexes, and has a pH 6.8, which then worsens to 6.7, then that's a different story).

[@havvasimsek6419]

👏🏻👏🏻👏🏻👏🏻👏🏻 thank you 😊

[@TalaTalksNICU]

Thank you as always Havva! You are a great cheer-leader :)

[@floatinggoose9197]

So, they got my son in within 6 hours, but he had a grade 4 brain bleed, Ventrical and surface. Odd

[@TalaTalksNICU]

We're so sorry- we really hope you and your son have as few complications as possible.

[@arunimabhardwaj4575]

Nyc maam

[@TalaTalksNICU]

Great! So happy you’re here :)

[@user-gy2ie3dn5y]

6 month baby now ,i got c section due to bp before the due date ,but baby pass meconium in the womb ,but baby is cry while born& not admitted in nicu. Is there any chance of baby brain get damage,due to passing a meconium i am really stressed & scared plz reply me

[@TalaTalksNICU]

Answered above

[@osamaalagamawy3891]

ما شاء اللة. بارك اللة فيكم.

[@TalaTalksNICU]

You have binged these- makes us so happy! Thank you!!

[@user-vt1ty3tn4b]

Is erythropoietin can be helpful in hie??? Can I start erythropoietin after 24 or 48 hour

[@TalaTalksNICU]

Hello! Is it Noor? (Poor arabic here!). This is such a great question- I feel like every few years erythropoietin comes out as a potential therapy to improve outcomes (whether in just boys or whatever)- and then further studies show it isn't that helpful after all. So we're not there yet with HIE but apparently there are continuing trials. I found this: www.ncbi.nlm.nih.gov/pmc/articles/PMC7073127/

[@victoriapettiford2397]

How does cooling effect blood clotting?

[@TalaTalksNICU]

Hi Victoria! Great question! So hypothermia can decrease platelet number and function in neonates. It can also affect the direct clotting cascade- slow down each activation step. These affects are more pronounced when the infant has acidosis (which is frequent when an infant is hypothermic). Thanks for watching!

[@surajkeshri5514]

Is this therapy helpful for hie adults ?

[@TalaTalksNICU]

Hello Suraj! We're not as up to date with adult literature- but generally therapeutic hypothermia has been shown to help in cases of cardiac arrests. There have also been several studies about how cooling could help in spinal cord injuries -which have been promising. (And every couple of seasons in American Football here, we hear about a player doing much better than expected because of early cooling after an injury). The logistics of cooling adults must be harder than neonates, since at least neonates are in the hospital when the injury happens. So the answer, is maybe! Hope this helps!!!

[@user-uw7ms4tt2m]

❤👍

[@TalaTalksNICU]

Thank you so much!

[@mcdonaldmetsileng6004]

Enjoyed the talk 😊

[@TalaTalksNICU]

We’re so glad! Thanks for letting us know :)