Neonatal Cooling Criteria

When to consider treatment with cooling

The following information comes from the UK TOBY Clinician's Handbook found here.

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 (defined as any occurrence of umbilical cord, arterial or capillary pH <7.00)
  • Base Deficit ≥ 16 mmol/L in umbilical cord or any blood sample (arterial, venous or capillary) within 60 minutes of birth

Infants that meet criteria A should be assessed for whether they meet the neurological abnormality entry criteria (B):

B. seizures or moderate to severe encephalopathy, consisting of:

  • Altered state of consciousness (reduced response to stimulation or absent response to stimulation) and
  • Abnormal tone (focal or general hypotonia, or flaccid) and
  • Abnormal primitive reflexes (weak or absent suck or Moro response).

Infants who meet criteria A and B may be considered for treatment with cooling. More information may be found at the UK Toby Register Handbook website.