Cooling in surgical patients: two case reports

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Critical Care

Background:

• Moderate induced hypothermia is standard care for peripartum hypoxic-ischaemic encephalopathy (HIE).
• Neonates with congenital abnormalities requiring surgery have been excluded from HIE cooling trials due to surgical risks.

Purpose of the Study:

• To report successful therapeutic hypothermia in two neonates with congenital conditions requiring surgical intervention.
• To evaluate the safety and feasibility of cooling in this high-risk population.

Main Methods:

• Two neonates meeting criteria for therapeutic hypothermia, one with duodenal atresia and another with congenital diaphragmatic hernia, were medically stabilized.
• Therapeutic hypothermia was initiated, and potential complications, including coagulation defects, were monitored and managed.
• Patients underwent successful surgical intervention after completion of hypothermia.

Main Results:

• Both neonates tolerated therapeutic hypothermia without significant complications.
• Medical stabilization and successful surgical repair were achieved in both cases.
• The study demonstrates the feasibility of combining hypothermia with surgical management.

Conclusions:

• Neonates with congenital conditions requiring surgery should not be excluded from therapeutic hypothermia if indicated for HIE.
• Careful monitoring and management can mitigate potential risks associated with cooling in surgical neonates.
• This approach may improve outcomes for infants with HIE and surgical comorbidities.