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A Communication Service for Physicians from CHOC and CHOC at Mission. Please Note: Physician Connection is no longer being printed and is now available electronically. Please visit our blog at http://docs.chocchildrens.org for the latest articles for our physician community. You can also receive our electronic Physician Connection newsletter in your inbox by subscribing to our mailing list: http://www.choc.org/subscribe

“Cool-Cap” Technology for Moderate or Severe HIE
Giving Newborns a Second Chance

We may be one of the youngest children’s hospitals in the nation, but our physicians have an impressive track record for implementing promising medical technology in neonatal medicine.

CHOC Children’s is once again at the forefront of neonatal care with the acquisition of “cool-cap” technology for newborns with moderate or severe hypoxic-ischemic encephalopathy (HIE). CHOC is the first hospital in the region, and second in Southern California, to offer the Olympic Cool-Cap System to prevent or reduce the severity of neurological injury associated with HIE.

The leading-edge technology has been shown to greatly reduce the risk of newborn death and disability.

Treatment must begin within six hours. CHOC has 24-hour neurological coverage, including EEG support, and a 24-hour NICU transport team on standby to ensure treatment begins as quickly as possible.

The 54-bed CHOC NICU is the only level 3C unit in the region. Last year, physicians sent more than 650 babies to CHOC for life-saving care.

As many as three of every 1,000 infants born in the U.S. will experience interrupted oxygen flow to the brain. Clinical trials have shown that temporarily lowering brain temperature by 2 to 5 degrees Celsius within six hours of birth may reduce the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy (HIE).

Available in the CHOC NICU, the Olympic Cool-Cap System cools the newborn’s brain for 72 hours and then slowly re-warms the patient for an additional four. The first patient was admitted into the unit for this special treatment in March.

“Cool-cap is one of many ways the CHOC NICU is improving the long-term quality of life for neonates,” said Vijay Dhar, M.D., medical director of the CHOC NICU. “This technology can make a tremendous difference in the lives of children throughout the region, and we are proud to be providing this technology.”

24-Hour NICU Transport Available
For more information about cool-cap treatment or to arrange a NICU transport, please call (714) 532-8540.

“Cool-Cap”referral criteria
If three criteria are met, cooling is to begin within six (6) hours of birth or sooner:

A. Infant at ≥ to 36 weeks GA and at least one of the following:

  • Apgar score ≤ 5 at 10 minutes after birth
  • Continued need for resuscitation 10 minutes after birth
  • Acidosis defined as either umbilical cord pH or any arterial pH within 60 minutes of birth ≤ 7.00
  • Base Deficit ≥ 16 mmol/L in umbilical cord blood sample or any blood sample within 60 minutes of birth, that is, arterial or venous blood 

B. Infant with moderate to severe encephalopathy consisting of altered state of consciousness (as shown by lethargy, stupor or coma) and at least one of the following:

  • Hypotonia
  • Abnormal reflexes, including oculomotor or papillary abnormalities
  • Absent or weak suck
  • Clinical seizures 

If the infant is paralyzed, assume an abnormal evaluation for criterion B and proceed to criterion C.

C. Infant has an electroencephalogram monitor of at least 20 minutes duration that show either moderately/severely abnormal EEG background activity (score of 2 or 3) or seizures.

  • The EEG should be performed after one hour of age and should not be performed within 30 minutes following intravenous (IV) anticonvulsant therapy as this may cause suppression for EEG activity.

Exclusion Criteria

  • GA <36 weeks gestation
  • Birth weight <1800 grams
  • Evidence of head trauma, skull fracture causing intracranial hemorrhage
  • Major congenital anomalies


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chocChildren's Hospital of Orange County | UCI University of California, Irvine

Children's Hospital of Orange County is affiliated with UC Irvine Healthcare and UC Irvine School of Medicine

CHOC Children's - 1201 W La Veta Ave, Orange, CA. Phone: 714-997-3000. .