West Midlands Neonatal Transfer Service
Therapeutic Hypothermia
Cooling Audit FiguresApr 2012 – Dec 2012
Nikki BakerNeonatal Transport Nurse
West Midlands Neonatal Transfer Service
Cooling Activity
April May June July August September October November December0
1
2
3
4
5
Requests
Actual Transfers
Refusals/ Cancellations
West Midlands Neonatal Transfer Service
BWH
City
Good
Hope
Linco
ln
New C
ross
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
West Midlands Neonatal Transfer Service
SWMNN
SSBCNN
CNN
22
11
2
Transfers requests from each network
West Midlands Neonatal Transfer Service
SWMNN
SSBCNN
CNN
19
1
11
Transfers Performed from each network
West Midlands Neonatal Transfer Service
BWH
Heartlands
New Cross
UHNS
Walsgrave
Unknown
0 3 6 9 12 15
Refusals
Cancellations
Transfers
Requests
Transfer To
West Midlands Neonatal Transfer Service
SWMNN
SSBCNN
1714
Transfers performed To each network
West Midlands Neonatal Transfer Service
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
West Midlands Neonatal Transfer Service
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
14
16
Number of transfers
Transfers performedResponse time (Call → Arrival on Ref. NNU)
West Midlands Neonatal Transfer Service
Within 5 hours
Within 6 hours
Within 7 hours
Within 8 hours
Within 9 hours
Within 10 hours
Within 11 hours
Within 12 hours
Greater than 12 hours
0
1
2
3
4
5
6
7
8
9
10
Number of babies
Transfers performedAge at Cooling centre
West Midlands Neonatal Transfer Service
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
West Midlands Neonatal Transfer Service
Active – inactivated transw
armer
Passive
0 2 4 6 8 10 12 14 16 18
Number of babies
Transfers performedMethods of cooling
West Midlands Neonatal Transfer Service
< 33°C
> 34°C
0 1 2 3 4 5 6
Number of babies
Transfers performedBabies not cooled
West Midlands Neonatal Transfer Service
Ventilated Ventilated + Nitric Oxide CPAP SVIA0
5
10
15
20
25
30
Number of babies
Transfers performedRespiratory support
West Midlands Neonatal Transfer Service
Morphine Morphine + Paralysis Nil0
2
4
6
8
10
12
14
16
18
Number of babies
Transfers performedParalysis & sedation
West Midlands Neonatal Transfer Service
Phenobarb Loading Dose Phenobarb Loading + Maintenance Nil0
2
4
6
8
10
12
14
16
Transfers performedPhenobarbitone use
West Midlands Neonatal Transfer Service
Dopamine
Dobutamine
Dopamine + Dobutamine
Nil
0 5 10 15 20 25
Transfers performedInotropic support
West Midlands Neonatal Transfer Service
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
West Midlands Neonatal Transfer Service
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.