Technical aspects of starting a neonatal cooling program

Clinicians who are convinced by the available evidence that cooling is a safe and effective treatment of hypoxic-ischemic encephalopathy in the term or near-term infant are now faced with a series of decisions around implementation of therapeutic hypothermia in their neonatal ICU or region. There is currently uncertainty about the efficacy of cooling or at least the magnitude of the effect, and precise estimates of the benefit of cooling must await the publication of the results of the several pending trials. This article assumes that clinicians are sufficiently convinced by the available evidence of safety and efficacy to proceed to the implementation step and offers guidelines for starting a neonatal cooling program.