Chapter 45 ■ Brain and Whole Body Cooling 341

7. Listen for the activation of the pump.

8. Check that the water flow indicator (Fig. 45.18F) is

rotating.

Initiate Post-Rewarming Care

When the rectal temperature has been 36.5°C for 60 minutes, the Blanketrol can be set to Monitor Only and the

infant can be kept normothermic (36.5 ± 0.2 °C) with a

servocontrolled overhead radiant warmer and overhead

reflective shield (Fig. 45.21).

1. Press Monitor Only (Fig. 45.19J).

2. Keep core temperature probe in place for 24 hours after

completion of cooling.

3. For radiant warmer, use servo control.

Place the skin probe over the liver, right upper quadrant, below ribs.

Set servo to achieve axillary temperature of 36.5 ±

0.2°C.

4. Cover the face and head with a reflective shield to prevent elevation of the superficial brain temperature (Fig.

45.21)

 Alternatively, the infant can be warmed in a

Babytherm infant warmer (Dräger Medical Inc.,

Telford, Pennsylvania) or any “hot cot,” which has the

option of increasing the temperature of the mattress,

by setting the temperature of the cot at the same temperature that the water in the Blanketrol was set at to

maintain the infant normothermic.

a. Place a six-layered bubble wrap “pillow” between

the infant’s head and the hot cot, to prevent elevation of the superficial brain temperature (Fig.

45.14B, D).

b. Discontinue hourly core temperature monitoring

after 24 hours, and resume routine 4 hourly temperature monitoring.

Precautions

1. Do not use deionized water. The majority of deionizers

do not maintain a neutral pH of 7.

This results in acidification of water, which can deteriorate the battery and the copper refrigeration line, ultimately leading to a leak in the refrigeration system.