Heinrick's Hypoxic Ischemic Encephalopathy Therapeutic Hypothermia Calculator

All term infants (> 36 weeks gestation) should be screened for cooling if they are admitted to the NICU with an admitting diagnosis of acute perinatal asphyxia, neonatal depression, encephalopathy, and/or fetal acidemia.

These infants at < 6 hours of age should be evaluated by clinical and biochemical criteria and further followed by neurological examination. Both inborn and outborn infants should be evaluated. It is important that clinical cooling not be delayed for the infant.

Is the neonate 35 weeks gestational age or greater and less than 6 hours old?

Is there a blood gas available?

Cord pH OR first postnatal gas within 1 hour with pH ≤ 7.0?

Base Deficit on cord gas OR first postnatal blood gas within 1 hour at ≥ 16 mEq/L

Was the pH between 7.0 and 7.15?

Was the pH between 7.0 and 7.15?

Was there an acute event that occured?

Was the Apgar score ≤ 5 at 10 minutes?

Continued need for ventilation initiated at birth and continued for at least 10 minutes?

Based on the information provided, this neonate should have an encephalopathy exam performed.

Based on the information provided, this neonate does not meet criteria for an encephalopathy exam. However, this algorithm is a guide and the decision to perform an encephalopathy exam is at the discresion of the health care provider.

Information and Background

This tool was developed using research enrollment criteria from the study, "Evaluation of Systemic Hypothermia Initiated After 6 Hours of Age in Infants 36 Weeks Gestation with Hypoxic-Ischemic Encephalopathy: A Bayesian Evaluation" from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) research network, part of the National Institutes of Health.

This tool should be used as a guide by a appropriately skilled health practitioner to determine possibility of using therapeutic hypothermia to treat hypoxic ischemic encephalopathy (HIE) at a facility that is able to perform this service. If a practitioner feels that a neonate could is at risk of HIE, the nearest appropriate facility should be contacted for consultation.

This tool was created using a combination of internet and web technologies (HTML 5, CSS, JavaScript, xCode, Swift). It is published on the internet and available to the world at https://www.hietool.org. It is also accessible via a Mobile Application available on iOS.

The original code for this website and the mobile application was developed by Dr. J. Ryan Heinrick MD during Neonatal-Perinatal Fellowship at Duke University in Durham, North Carolina from 2015 - 2018.

Another web based application created by Dr. Heinrick for use in both the newborn nursery and the NICU is the Transcutaneous Bilirubin Tool, or TCBTool. This is available at http://www.tcbtool.org

Currently Dr. Heinrick is a Clinical Assistant Professor, Clinical Series, Child Health, Division of Critical Care at University of Arizona College of Medicine - Phoenix. For questions or comments, please contact Dr. Heinrick here: rheinrick@gmail.com

Base Deficit on cord gas OR first postnatal blood gas within 1 hour at ≥ 16 mEq/L

Continued need for ventilation initiated at birth and continued for at least 10 minutes?

Clinical concern for Seizures?

Level Of Consciousness?

Spontaneous Activity?

Posture?