West Midlands Neonatal Transfer Service Therapeutic Hypothermia Cooling Audit Figures Apr 2012 –...

West Midlands Neonatal Transfer Service

Therapeutic Hypothermia

Cooling Audit FiguresApr 2012 – Dec 2012

Nikki BakerNeonatal Transport Nurse


Cooling Activity

April May June July August September October November December0

1

2

3

4

5

Requests

Actual Transfers

Refusals/ Cancellations


BWH

City

Good

Hope

Linco

ln

New C

ross

Reddit

ch

Russe

ll’s H

all

Staffo

rd

Wals

all

War

wick

Wor

cest

er0

1

2

3

4

5

6

7

8

9

10

Requests

Transfers

Cancellations

Refusals

Requests from


SWMNN

SSBCNN

CNN

22

11

2

Transfers requests from each network


SWMNN

SSBCNN

CNN

19

1

11

Transfers Performed from each network


BWH

Heartlands

New Cross

UHNS

Walsgrave

Unknown

0 3 6 9 12 15

Refusals

Cancellations

Transfers

Requests

Transfer To


SWMNN

SSBCNN

1714

Transfers performed To each network


Within 1 hour

Within 2 hours

Within 3 hours

Within 4 hours

Within 5 hours

Within 6 hours

Greater than 6 hours

0

2

4

6

8

10

12

Number of babies

Transfers performedReferral age


Within 1 hour

Within 2 hours

Within 3 hours

Within 4 hours

Within 5 hours

Within 6 hours


0

2

4

6

8

10

12

14

16

Number of transfers

Transfers performedResponse time (Call → Arrival on Ref. NNU)


Within 5 hours

Within 6 hours

Within 7 hours

Within 8 hours

Within 9 hours

Within 10 hours

Within 11 hours

Within 12 hours


0

1

2

3

4

5

6

7

8

9

10

Number of babies

Transfers performedAge at Cooling centre


Within 2 hours

Within 4 hours

Within 6 hours

Within 8 hours

Within 10 hours

Not recorded by NTS

0

2

4

6

8

10

12

Number of babies

Transfers performedAge 33-34°C Achieved


Active – inactivated transw

armer

Passive

0 2 4 6 8 10 12 14 16 18

Number of babies

Transfers performedMethods of cooling


< 33°C

> 34°C

0 1 2 3 4 5 6

Number of babies

Transfers performedBabies not cooled


Ventilated Ventilated + Nitric Oxide CPAP SVIA0

5

10

15

20

25

30

Number of babies

Transfers performedRespiratory support


Morphine Morphine + Paralysis Nil0

2

4

6

8

10

12

14

16

18

Number of babies

Transfers performedParalysis & sedation


Phenobarb Loading Dose Phenobarb Loading + Maintenance Nil0

2

4

6

8

10

12

14

16

Transfers performedPhenobarbitone use


Dopamine

Dobutamine

Dopamine + Dobutamine

Nil

0 5 10 15 20 25

Transfers performedInotropic support


Stabilisation

• Stabilisation times varied from 1hour 17mins to 11hrs 55mins.

• Clinical factors influencing stabilisation included;

♦ Intubation ♦ Umbilical line insertion

♦ X-ray confirmation ♦ Loading dose phenobarbitone

♦ Starting morphine ♦ Starting inotropes

• Other factors influencing stabilisation included;

♦ Counselling parents ♦ NTS shift handover

♦ TOBY paperwork ♦ Discharge letter


The future Joint network therapeutic hypothermia study day;

Early recognition of babies meeting criteria Early clinical management of these babies Rapid referral to Cooling Centre Rapid referral to NTS.

All neonatal units using rectal temperature monitoring as gold standard.

Use of Tecotherm mattress on transfers; Earlier achievement of 33-34°C Reducing incidents of temperature fluctuations

Plans for an educational DVD on early management of cooling babies.

West Midlands Neonatal Transfer Service Therapeutic Hypothermia Cooling Audit Figures Apr 2012 –...

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