1. Jessica Gosney 25 th February 2015

2. * Background * Aims * Methods * Standards * Results * Discussion * Recommendations

3. * Perinatal asphyxial encephalopathy is associated with high morbidity and mortality. * Reducing body temperature reduces cerebral injury and improves neurological function. * Assess current practice regarding neonates who meet the criteria for cooling. * Identify areas of good practice and areas which require improvement to comply with the TOBY guidelines. * Deliver best evidence-based care to this group of patients.

4. * A. Infants ≥36 completed weeks gestation admitted to the neonatal unit with at least one of the following: * Apgar score of ≤5 at 10 minutes after birth * Continued need for resuscitation, including endotracheal or mask ventilation, at 10 minutes after birth * Acidosis within 60 minutes of birth (pH <7.00) * Base Deficit ≥ 16 mmol/L in any blood sample within 60 minutes of birth * Infants that meet criteria A should be assessed for criteria (B): * B. seizures or moderate to severe encephalopathy, consisting of: * Altered state of consciousness * Abnormal tone or primitive reflexes * Relative contraindications: * Conditions requiring immediate or imminent surgery * Abnormalities indicative with poor long term outcome * Severe HIE, moribund

5. * Initial research * Monitoring demand and identifying adverse events * Uniform management for high risk patients * Documentation: * Target temperature * Tight control – pyrexia affects outcome * CFM * Future research

6. * Retrospective and prospective review of patients referred for active cooling from February 1 st 2014 to January 31 st 2015. * Identified from Badgernet. * Review of clinical notes and Badgernet summaries. * Trust & Network guidelines on Cooling & HIE. August 2014. * TOBY cooling register, www.npeu.ox.ac.ukwww.npeu.ox.ac.uk

7. * 100% of patients eligible for cooling should: * have passive cooling commenced within 1 hour of birth, and time commenced documented. * be discussed with the regional cooling centre, and have this discussion documented. * have their treatment plan discussed with the parents, with the discussion clearly documented. * reach their target temperature within 6-8 hours of birth. * have temperature monitored every 15 minutes. * have CFM/aEEG commenced. * have the TOBY register checklist completed. * 100% of patients who received cooling should have follow up as an outpatient.

8. * 5 patients were referred and accepted for cooling: * 4/5 met Criteria A * 5/5 met Criteria B * 4/5 were cooled within 1 hour of birth (1 postnatal collapse) * All had continuous rectal temperature monitoring * All had a documented discussion with a regional cooling centre * All had CFM initiated * All reached target temperature within 6-8 hours

9. * 2/5 had no documented discussion with parents regarding cooling * 2/5 had no TOBY cooling checklist in notes * 2/5 had follow up, 3/5 passed away

10. * Small sample size * Overall compliance with standards apart from discussion/documentation * Importance of documentation: * TOBY checklist * Discussion with parents

11. * Longer duration of audit with larger sample * Reiterate importance of documentation to staff: * TOBY checklist * Discussion with parents * Re-audit in 6 months to monitor affect of changes.