Therapeutic hypothermia (cooling) is neuroprotective and has become the standard of care for infants with moderate to severe hypoxic-ischemic encephalopathy (HIE). However, cooling is offered only at high level neonatal intensive care units, which necessitates transporting sick infants to tertiary care centers.

HIE can lead to severe neurodevelopmental outcomes and death, and cooling can reduce mortality and morbidity. Therefore, it is imperative for pediatricians and other health care professionals attending the birth of a child to recognize newborns with HIE who might be candidates for cooling.

HIE is characterized by two phases of injury, a primary and secondary phase, separated by a short recovery phase. Cooling decreases brain metabolism, conserves energy and prevents secondary energy failure and cell death. Hence, the goal of cooling is to stop injury progression after the HIE insult, so there is no secondary injury phase.

The decision to initiate cooling following HIE is based on...

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