Cooling of newborns with PCM

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Cooling of newborns with PCM

• Inst. Kvinnor och Barnshälsa Karolinska institutet

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Background

• All over the world people are getting ill, with
  fever as a result.
• Young children have less possibilities to coop
  with fever.
• Neonatal children gets fever cramps or even
  sometimes dies due to fever.
• Children are getting brain injuries due to
  hypoxia.

• Inst. Kvinnor och Barnshälsa Karolinska
  institutet

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What can be done?

• Normal people can be treated with medicine, be
  kept in cold rooms, e.g.
• Young children can be treated in many ways, for
  example with cold towels, medicine, chilled rooms
  e.g. to keep the temperature down in hospitals.
• Hypoxia has been treated in different ways due to
  the knowledge of doctor, to minimize brain
  damage.

• Inst. Kvinnor och Barnshälsa Karolinska
  institutet

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History of Cooling

• 1684 Cooling of the whole patient was tested and
  then made as praxis for the treatment of
  syphilis.
• 1797 Women was treated before seizures.
• 1964 Since this year the treatment by cooling the
  heart has made cardiac surgery safer.
• 1968 Body cooling for adults.
• 1968 First animal experiment show that cooling
  puppets with 1degree helped survival rate.

• Inst. Kvinnor och Barnshälsa Karolinska
  institutet

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Aims

• Our aims are
• to find a treament that can replace traditional
  methods for the childrent with hypoxia and fever
  cramps.
• to find a way to cool children during transports.
• find a way of cooling that are not only for the
  really rich.
• make it possible for the thirdworld to cool
  children.

• Inst. Kvinnor och Barnshälsa Karolinska
  institutet

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How are these children get treated today?

• In most hospitals in the industrial world
  treatment to chill children are done by one or
  more of the folowing options

• Towel method
• Aircondition method
• Whole body/head cooling by water madress
• No cooling/heating as the rest of the children
  (with no problem)

• Between hospitals as well in third world

• Towel method
• By ice/coolpacs
• No cooling

• Inst. Kvinnor och Barnshälsa Karolinska
  institutet

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Problems with traditional methods of treatments.

• Air conditioned room

• Bacteria is moving around.
• Temperature in the room differs from the one at
  the patient.
• Unstable temperatures in the room.
• Slow

• Towel method

• Bacteria is moving around.
• Temperature changes within the towel occures.
• Bad control of how much the patient are chilled.
• Slow.

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Problems with traditional methods of treatments.

• Whole body coolingwith watermadress

• Expensive
• Need for equipmentg to pump the water
  around.control the temperature e.g.

• Ice/ cool pacs for transport

• Works only if you have a fridge near by.
• Bad control of how much the patient are chilled.
• Can injure more than it helps.

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Coolcaps/ whole body cooling advantages.

• Whole body coolingwith watermadress

• Exact temperature control of the patient and the
  water moving around can be achived at all times.
• There have been companies that have supported
  trials, and they are continueing to develop
  equipment for this.
• In England a multi-center study is done called
  TOBY

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Both TOBY and our temperature set up
In both the TOBY clinical trials and our clinical
trial the following set up has and will be used
37
34
0
72
Hours
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Measurements

• We intend to measure the following parameters
• Temperature from 3 points, rectal, lung, and
  scull. (We also will have a few extra check
  points )(CFM from the scull, (an aEEG )
• Enviroment heat, air humidity, our equipments
  temperature

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Other parameters

• Other parameters we will take into our protocol
  in the study
• Stress we will use the NIDCAP protocol, to
  control that we dont stress the children more
  than absolutly nessesary.
• NIRS, a way to measure diffrent part of the brain
  function.
• Enviroment stress.
• All other treatment and medicine each patient are
  prescribed by doctors, and other staff.

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When will we start

• We have already started to collect the equipments
  needed.
• We have also applied for ethical control and ok
  from the swedish goverment.
• We have started to make the diffrent headcaps and
  mattreses but we need to find the right
  PCM-sollusions and fill the above.
• First patient will be done this summer