Therapeutic Hypothermia

HIE cooling eligibility (NICHD / TOBY criteria)

Educational decision support · Not a medical device · Do not enter PHI

Eligibility

Does not yet meet cooling criteria

Cooling must begin by 6 hours of life. If a patient is borderline, contact your cooling center immediately — eligibility decisions are time-critical.

✓Inclusion (GA / BW / age)
○A. Perinatal acidosis / event
○B. Moderate–severe encephalopathy

Inclusion criteria

GA (weeks)≥ 36Birth weight (g)≥ 1800Age now (hours)≤ 6

A. Perinatal acidosis / sentinel event

Either a severe gas, OR a moderate gas PLUS an acute perinatal event with depression at 10 min.

Cord or 1-hr pHSevere ≤ 7.00 · Moderate 7.01–7.15Base deficit (mEq/L)Enter as negative. Severe ≤ −16 · Moderate −10 to −16Apgar at 10 minSupports moderate path if ≤ 5

Still requiring resuscitation at 10 minAcute perinatal event (abruption, cord prolapse, uterine rupture, severe FHR decel, etc.)

Need pH ≤ 7.00 / BE ≤ −16, OR pH 7.01–7.15 / BE −10 to −16 with an acute event AND (Apgar ≤ 5 at 10 min OR ongoing resus at 10 min).

B. Modified Sarnat exam

Moderate–severe encephalopathy = abnormal findings in ≥ 3 of 6 categories.

Level of consciousness

Spontaneous activity

Posture

Tone

Primitive reflexes (suck / Moro)

Autonomic (pupils / HR / respirations)

Abnormal categories: 0 / 6

Educational decision-support only. Confirm with your unit's neuroprotection protocol and consult your cooling center.

Inclusion criteria

A. Perinatal acidosis / sentinel event

B. Modified Sarnat exam

Important Notice