Therapeutic hypothermia on transport: providing safe and effective cooling therapy as the link between birth hospital and the neonatal intensive care unit.

Therapeutic hypothermia as a neuroprotective strategy in neonates is an established standard of care for infants with hypoxic-ischemic encephalopathy (HIE) in tertiary care neonatal intensive care units (NICUs). To maximize the neuroprotective effect in infants with HIE, hypothermia is initiated as soon as possible after birth. Many infants who would benefit from therapeutic hypothermia are not born at centers that have intensive care units or offer therapeutic hypothermia and are thus transported to a tertiary care center with a NICU, offering specialty services of therapeutic hypothermia and pediatric neurology. The neonatal transport team plays a significant role in the management of these critically ill infants. Clinical research provides data for safe and effective management of these infants during therapeutic hypothermia in the NICU; however, there are no evidence-based clinical guidelines for management before and during transport. The establishment of evidence-based guidelines for cooling before and during transport will facilitate early recognition of infants who would benefit from therapeutic hypothermia therapy, and decrease delay in initiation of therapy. Careful assessment, monitoring, and intervention by the transport team are critical to provide appropriate care and ensure safe transport of these infants.